Appeals Specialist II

The Appeals Specialist II, under the direction of the Director of Denial Support Services, logs and reviews per documentation guidelines for report trending. This position provides SSC and ancillary departments all payor updates regarding billing and coding updates/changes, completes timely and consistently reports project status SSC leadership and maintains confidentiality of data and information. This position provides feedback to facilities regarding denials that are resulting in retractions.

As an Appeals Specialist II at Community Health Systems (CHS) - SSC Nashville, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision, insurance, and 401k.

Essential Functions

• Responsible for review and resolution of pre pay insurance denials, correlating with the follow-up teams.
• Works closely with Denial Coordinator, Facility Denial Liaison, and Managed Care Coordinator for education and payer accountability.
• Consults with managers and staff on developmental needs for new processes and makes recommendation to change.
• Maintains knowledge of practice management systems, basic coding and billing knowledge, customer service techniques, basic insurance/carrier knowledge, and front office operation policies.
• Gathers and makes available appropriate educational resources (e.g. books, video tapes/audio Works with associates, departments and facilities to understand denial/appeal management processes.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Bachelor's Degree in Nursing preferred
• 1-3 years experience in healthcare revenue cycle or business office required
• 1-3 years experience in healthcare insurance medical billing preferred

Knowledge, Skills and Abilities

• To perform this job successfully, an individual should have knowledge of Word Processing software, spreadsheet software and database software.

Licenses and Certifications

• RN-BC - Certified General Nursing Practice current license to practice in state required

We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. The Shared Services Center - Nashville provides business office support functions like billing, insurance follow-up, call center customer service, data entry and more for hospitals and healthcare providers. But we're not only about work. We know employing a skilled and engaged team of professionals is vitally important to our success, so we make sure to offer competitive benefits, recognition programs, professional development opportunities and a fun and engaging team environment.

Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.