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)
DEFINITION:
Denials and Resolution Analyst is under the supervision of one of the MedAccounts Service Supervisors. The Denials and Resolution Analyst is responsible for follow-up and monitoring under-payments from Third party payers. Responsible for data collection and analysis regarding specific Provider and/Facility Inquiries, Disputes and/or Appeals. Develops necessary policies and procedures and oversees quality assurance measures related to Provider and Hospital Disputes.
PREFERRED QUALIFICATIONS:
Must have good organizational skills, reading, writing and proven communication skills.
Proficient in Excel.
Must have 2 years of general medical office experience.
Prefer 2 year of hospital/medical office billing and collections or can demonstrate an understanding of hospital/physician billing and collections.
College degree preferred.
High School Graduate with excellent organizational skills, ability to work independently and stay on task,
Ability to learn and understand billing protocol and reimbursement issues, ability to maintain accurate and detailed charts/notes in the company system.
2 years formal education in business or equivalent experience.
Must have at least 2 years of a Medical Office/Hospital billing setting.
Clear All
0 Appeal Resolution Manager jobs found in Lawton, OK area