Appeal Resolution Specialist logs, tracks, and processes appeals and grievances. Sets up and maintains case files for each grievance and collects the information required by organizational policies and applicable regulations. Being an Appeal Resolution Specialist conducts research and coordination needed to evaluate, process, respond to, and refer or close appeals. May require an associate degree or equivalent. Additionally, Appeal Resolution Specialist typically reports to a supervisor. The Appeal Resolution Specialist works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be an Appeal Resolution Specialist typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
Responsibilities:
Assists with all clerical and administrative aspects of mammography workflow including but not limited to: Assists with Rad/Path input, Assists with written/verbal timely communication, Assist with Birads letters mailing, follow up, Assists with ensuring all exams are resulted timely or followed up accordingly, Ensures STAT/priority reports are transcribed timely, Assists with needed addendum tracking, Performs importing of all outside imaging, managing the schedule to ensure appropriate outside imaging is received timely to ensure timely release of results, Mails/faxes all reports and letters to referring physicians and patients, in accordance with FDA/MQSA guidelines, Provides department support with Epic workflow, Performances QA for reports and Birads letters tracking, Tracks patients due/past due for follow up, proactively coordinates with scheduling, Serves as relief for front desk and scheduling, Supports workflow with appropriate engagement in WQs related to reports, billing, scheduling, etc., Works closely with Breast Center management team, advising of any problems encountered with reports, billing, etc and offers suggestions for improvement
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