Medical Appeals Specialist

Job Description

Job Description

The Weston Group, a national provider of rehabilitation services, is dedicated to providing evidence-based, person-centered therapeutic services to our residents. We are proud to remain a therapist-owned and operated company that believes in a unique and innovative approach to geriatric care.

We are currently seeking a dedicated Medical Appeals Specialist to join our team on a full-time or part-time remote basis.

POSITION SUMMARY:

The Medical Appeals Specialist oversees the processing of Medicare and other insurance appeals and fulfills medical records requests.

POSITION DUTIES/RESPONSIBILITIES:

• Monitor the Medical Review email
• Download medical charts from the EMR sheet
• Prepare medical charts for submission in the appeals process and submit either by mail, facsimile or applicable portal
• Maintain spreadsheets of medical records submission history
• Organize spreadsheet and transfer data to workbooks once submitted
• Create reproducible and reliable reports using real data
• Maintain meticulous attention to timelines, details, and Medicare requirements
• Create reports to measure the current amount of billing under review, outcome and document recoupment totals
• Communicate documentation requirements as well as recent changes to documentation requirements to management
• Other responsibilities as determined by Director of Compliance
• Communication will be accurate, efficient, effective, and in a professionally friendly manner with providers, internal, and external staff
• Meticulous attention to timelines, details, and Medicare requirements

QUALIFICATIONS/SKILLS REQUIRED:

• Professional degree in a healthcare discipline. Licensed clinical providers are preferred.
• 3+ years previous experience in medical review and appeals process
• Excellent organization and documentation skills
• Experience with an EMR system, ability to use Excel and online portals
• Experience with Word, Excel, and Outlook
• Proven record of successful outcomes as measured by former employer

PHYSICAL DEMANDS:

• Must demonstrate appropriate and applicable fine motor skills
• Must be able to sit or stand while using a computer