Appeals Specialist I

As an Appeals Specialist at Community Health Systems, 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 health insurance, flexible scheduling, 401k and student loan repayment programs.

Required:

A minimum of six months of related experience is required.

Proficiency with Microsoft Word

Education: High School Diploma or equivalent

About the Opportunity:

Essential Duties and Responsibilities:

• Workflow Management and Communication: The Appeals Specialist is responsible for managing workflows related to Humana PPI Audits, RAC Audits, and Outpatient Appeals. This role involves daily communication with the Senior Director or Manager to report on identified trends and ensures that all aspects of the audit and appeal processes are handled efficiently.
• Query Response and Documentation: The specialist must respond to queries within a 72-hour timeframe, accurately documenting all interactions in systems such as Cerner, ClaimIQ, or Artiva, and meticulously tracking activities in the Appeal Tracker.
• Revenue Cycle: The role includes managing the Post-Appeal Follow-Up (PDFU) process to ensure timely account follow-ups, thereby facilitating effective movement through the revenue cycle.
• Claims and Project Assistance: The specialist handles claim appeals, assists with various projects as required, and submits requests for medical records, UB forms, and itemized bills.
• Compliance: The specialist is expected to stay informed about current department policies and procedures and to meet or exceed quality and quantity benchmarks set by management. This includes productivity, accounts receivable days, cash collections, bad debt management, and follow-ups on past due accounts.
• Confidentiality and Additional Duties: Maintaining patient confidentiality by adhering to HIPAA guidelines is crucial. The specialist must also be prepared to perform any additional duties as assigned or requested by management.

This is a full time, remote position at Shared Services Center - Sarasota in the Appeals Department. 

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.

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 70 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.

INDSSFLRCSC