Appeal Resolution Manager jobs in Everett, WA

Appeal Resolution Manager manages the grievance process to review, investigate, document, process, negotiate, and resolve disputed medical, insurance, and other claims. Oversees work activity that is compliant with all regulatory guidelines and policy protocols. Being an Appeal Resolution Manager allocates team resources to ensure an effective and balanced case workload. Applies industry standards and uses best practices in the preparation of legal briefs. Additionally, Appeal Resolution Manager may represent the organization at hearings. Requires a bachelor's degree. Typically reports to a senior manager or head of a unit/department. The Appeal Resolution Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be an Appeal Resolution Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)

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Patient Accounts Specialist - Account Resolution
  • CHC of Snohomish County
  • Everett, WA FULL_TIME
  • Community Health Center of Snohomish County offers competitive wages and a comprehensive benefits package designed to address health, time off, retirement and career-advancement needs.  Benefits available include health insurance (medical/dental/vision), up to 120 hours of vacation time pro-rated by FTE every 12 months, paid sick leave, 10-paid holidays, 403(b) Safe Harbor retirement plan with employer match, disability and life insurance, and more! We also offer $0.75/hour for those who test proficiently in a second language.

    Job Summary

    The Patient Accounts Specialist – Account Resolution is a billing and coding position that is primarily responsible for follow up operations in assigned areas of cash posting, collections, payment posting and validation, and customer service for a multi-specialty community health center.  This position requires a working knowledge of CPT, HCPC, and ICD codes as well as knowledge and experience with resolution of billing discrepancies, collection processes, and basic accounting principles.  Patient Accounts Specialists also serve as a communication link with clinical staff and are expected to communicate with them as needed while adhering to proper billing and coding guidelines.

    Knowledge, Skills & Abilities

    • Reads, speaks, understands and writes proficiently in English.
    • Works independently and is self-directed.
    • Works effectively in a team environment.
    • Problem-solves with creativity and ingenuity.
    • Organizes, prioritizes, and coordinates multiple activities and tasks.
    • Works with initiative, energy and effectiveness in a fast-paced environment.
    • Produces work in high quantity and quality.
    • Remains calm and effective in high pressure and emergency situations.
    • Use of multi-line telephones and other office machines.
    • 10-Key: 150 kpm with a 97% accuracy rate.
    • Knowledge of dental terminology.
    • Knowledge of HIPAA regulations and compliance.
    • Ability to make decisions regarding sensitive information.
    • Proficiency in the use of Microsoft Office applications; Word, Excel and Outlook.

    Preferred:

    • Knowledge of dental terminology.
    • Knowledge of healthcare revenue cycle functions, including documentation, coding, and billing guidelines.
    • Knowledge of government rules and regulations as it pertains to compliance billing practices, using National Correct Coding Initiatives (NCCI), and third party payer rules.
    • Bilingual skills.
    Education
    • High school graduate or equivalent.

    Preferred:

    • Graduate of an accredited Medical or Dental Billing Certificate program.

    Experience 

    • Customer service related experience working with the general public (2 years).
    • ICD-10 coding experience (1 year); or a combination of equivalent education and work experience.
    • CPT-4 coding experience (1 year); or a combination of equivalent education and work experience.
    • Data entry experience (2 years).
    • Working with insurance/billing in a healthcare setting (2 years).
    • Working with private and/or government third party reimbursement (1 year).
    • Reading remittance advice and explanation of benefits (EOB) across various payer sources experience (1 year).

    Preferred:

    • CDT-5 coding experience.
    • Healthcare information systems, such as electronic health record and practice management systems experience (3 years).
    • Working with low income, multi-ethnic populations.
    • Understanding of electronic auto posting technology related to 835 files.
    • Understanding of standard American National Standards Institute (ANSI) reason codes.
    Credentials
    Preferred:
    • Certified Professional Coder (CPC) by the American Academy of Professional Coders (AAPC) or Coding Specialist (CCS) certified by the American Health Information Management Association (AHIMA).

    Job Specific Functions/Performance:

    1. Verifies insurance coverage and submits claims to insurance companies.
    2. Assists patients in setting up payment plans and completes payment plan contracts.
    3. Posts daily payments to practice management system and enters contractual adjustments, as necessary. Ensures that all payments, adjustments and denials are posted timely and accurately. Tracks and follows up on appeals and corrections in a timely manner.
    4. Adheres to established quality and quantity standards of the department.
    5. Consults with Certified staff to receive written approval before changing codes, including, but not limited to, codes listed on current delegation list.
    6. Serves as a resource for staff on all aspects of insurance programs, discount applications, provider coding, payment plans and patient payment processing.
    7. Performs all aspects of A/R resolution, including, but not limited to, researching denied and incomplete claims and using appropriate methods for appeals and corrected claims.
    8. Stays current with payer requirements regarding overpayments, takebacks, claim corrections, and submissions.
    9. Performs various collection actions, including but not limited to, correcting and resubmitting claims to third party payers and tracking and reporting delinquent accounts to collection agency.
    10. Prepares and sends patient statements.
    11. Assists with processing discount fee adjustments and enters tracking data into sliding fee database.
    12. Scans various documents, including, but not limited to, statement verifications, collections, OB billing and invoices.
    13. Ensures all customer service inquires have been addressed. This includes researching patient questions regarding accounts/statements and initiates appropriate corrections, adjustments and/or resubmission of claim(s). Reconciles patient credit balances and initiates refund requests.
    14. Researches and reconciles patient and third party credit balances and initiates refund requests.
    15. Adheres to attendance standards in order to perform the job functions for daily operations and/or continuity of patient care.

    CHC is an Equal Employment Opportunity/Affirmative Action Employer (EEO/AA)/At-will employer.

  • 27 Days Ago

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Manager
  • Liquid Courage Karaoke and Escape Rooms
  • Everett, WA FULL_TIME
  • Overview:Seeking a dynamic and dedicated individual to lead our vibrant Karaoke and Escape Room entertainment venue as Manager. As the heartbeat of our establishment, you'll orchestrate unforgettable ...
  • 1 Day Ago

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Store Manager
  • Endicott Enterprises
  • Greenbank, WA FULL_TIME
  • Store Manager ***** This position is likely to start in October-November. ***** Responsibilities and Duties Manage store activity and ensure it is properly provisioned and staffed. -Inventory manageme...
  • 19 Days Ago

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General Manager
  • Wendy's | WTC Ventures United States
  • Lake Stevens, WA FULL_TIME
  • We're looking for outgoing and energetic General Managers! General Managers provide the vision and leadership to all Crew, Shift Supervisors and Restaurant Managers to ensure that each customer's expe...
  • 20 Days Ago

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Office Manager
  • H&R Block
  • Everett, WA FULL_TIME
  • Serve as the front-line manager responsible for leadership and development of associates in Block Advisors Office(s). Lead office, including tax accountants, in delivering an outstanding client experi...
  • 20 Days Ago

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District Manager
  • Jack In The Box
  • Arlington, WA FULL_TIME
  • This job posting is for a position in a restaurant owned and operated by an independent franchisee, not Jack in the Box Inc. This means the independent franchisee, and not Jack in the Box Inc., will b...
  • 20 Days Ago

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0 Appeal Resolution Manager jobs found in Everett, WA area

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Personal Injury Paralegal
  • Osborn Machler PLLC
  • Seattle, WA
  • Job Description Job Description We are a small PI firm in Seattle handling a high-volume of cases. We currently have thr...
  • 3/28/2024 12:00:00 AM

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Paralegal - Temporary
  • City of Kirkland
  • Kirkland, WA
  • Salary $77,841.09 - $101,564.94 Annually Location Kirkland, WA Job Type Full-Time Job Number 202100388 Location City Att...
  • 3/27/2024 12:00:00 AM

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Benefits Attorney
  • Solid Ground
  • Seattle, WA
  • Help ensure that everyone who needs public benefitscan access them. Job Summary The Benefits Attorney provides civil leg...
  • 3/27/2024 12:00:00 AM

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Claims Adjuster
  • Pacific Compensation Insurance Company
  • Seattle, WA
  • ** Claims Adjuster** **Job Category****:** Insurance Claims Adj **Requisition Number****:** CLAIM01143 Showing 1 locatio...
  • 3/26/2024 12:00:00 AM

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Senior Manager, US Legal (Remote)
  • Acxiom LLC
  • Seattle, WA
  • Acxioms US Legal Leader leads a team of attorneys who are responsible for developing, reviewing and negotiating client, ...
  • 3/26/2024 12:00:00 AM

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LEGAL ASSISTANT, CRIMINAL DIVISION
  • Kitsap County, WA
  • Port Orchard, WA
  • Salary: $22.45 - $31.73 Hourly Location : Port Orchard, WA Job Type: Full Time (40 hrs/wk) Department: Office of the Cou...
  • 3/25/2024 12:00:00 AM

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Remote Part-Time Contracts Paralegal
  • Boutique Recruiting
  • Bothell, WA
  • A leading data processing firm is searching for a Remote Part-Time Contracts Paralegal! They are looking for a paralegal...
  • 3/24/2024 12:00:00 AM

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Broadway Animal Hospital- Medical Director
  • PetVet Care Centers
  • Everett, WA
  • Position Overview: The Medical Director (MD) is responsible for providing strong leadership for the hospital, managing a...
  • 3/24/2024 12:00:00 AM

Everett is the county seat of and the largest city in Snohomish County, Washington, United States. It is located 25 miles (40 km) north of Seattle and is one of the main cities in the metropolitan area and Puget Sound region. Everett is the seventh-largest city in Washington state and had a total population of 103,019 at the 2010 census. The city is located at the mouth of the Snohomish River along Port Gardner Bay, an inlet of Possession Sound (itself part of Puget Sound). American settlement on the Everett peninsula began in the 1860s, with several sawmills built to serve the area's growing ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Appeal Resolution Manager jobs
$101,137 to $131,441
Everett, Washington area prices
were up 2.9% from a year ago

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