Appeal Resolution Specialist jobs in Bradenton, FL

Manatee Physician Alliance LLC

Manatee Physician Alliance LLC is a Medical Group that has 18 practice medical offices located in 1 state 3 cities in the USA. There are 45 health care providers, specializing in Preventative Medicine, Internal Medicine, Family Medicine, Psychiatry, Nurse Practitioner, General Surgery, Hospice/Palliative Care, Emergency Medicine, Neurology, Family Practice and more, being reported as members of the medical group. Medical taxonomies which are covered by Manatee Physician Alliance LLC include Surgical, Emergency Medicine, Student in an Organized Health Care Education/Training Program, Specialist, Psychiatry, Adult Health, Obstetrics & Gynecology, Family, General Practice, Surgery and many more.

Position Summary:

Responsible for scheduling referrals for patients, providers, pre-authorizing & pre-certing tests/procedures. Scheduling of other tests with facilities at the request of providers and/or staff. Directly communicates with the clinics, referred to clinics, and patients. Reviews clinical data to report medical necessity to insurance companies. Performs all work with accord to the mission, vision and values of the practice.

Independence Physician Management (IPM), a subsidiary of UHS, was formed in 2012 as the physician services unit of UHS. IPM develops and manages multi-specialty physician networks and urgent care clinics which align with UHS acute care facilities. It also provides select services for the Behavioral Health division of UHS. Through continuing growth, IPM operates in 11 markets across six states and the District of Columbia. Our leadership team, practitioners, and teams of healthcare professionals are collectively dedicated to improving the health and wellness of people in the communities we serve.

As a Manatee Physician Alliance employee you will be part of a first class organization offering:

• A Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match

About Universal Health Services (UHS), Inc.

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $14.3 billion in 2023. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 96,700 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Education:
 High school graduate or GED required.  

Work experience: Minimum of two years’ experience in a healthcare or clinical setting.

Knowledge:

Knowledge of clinical terminology, insurance billing, procedural and diagnosis coding, federal and state insurance regulations and HIPAA privacy standards is strongly preferred.

• Typing, 10 key and computer skills required.
• Proficiency in Microsoft Office applications required.
• Required effective interpersonal skills and excellent written, oral communication skills required.
• Acute healthcare knowledge and ability to evaluate clinical data to acquire pre-authorizations and referrals is preferred. Knowledge of third party reimbursement regulations is preferred.
• Patient Management, Billing and Managed Care system processes competency. Understanding of functions and work flow of Clinical/Hospital departments.
• Excellent planning and organizational skills. Demonstration of strong analytical skills and problem-solving abilities. Strong teamwork skills and the ability to effectively communicate with all management levels.
• Results oriented, independently goal directed, able to multi-task and meet established time frames.

        • Excellent customer service skills and must be able to work independently

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852- 3449