Appeal Resolution Specialist jobs in Mount Pleasant, SC

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)

M
Legal Resolution Specialist
  • MUSC
  • Charleston, SC FULL_TIME
  • Job Description Summary

    This role will act as an internal liaison between the Medical University of South Carolina (MUSC) and Newby, Sartip, Masel & Casper, LLC (Commonly referred to as “Sartip”). This role support the vendor relationship by monitoring vendor contracts and monthly invoices. Create and maintain reporting of weekly incoming Sartip checks for the monthly Sartip Report.

    Entity

    University Medical Associates (UMA) Only Employees and Financials

    Worker Type

    Employee

    Worker Sub-Type​

    Regular

    Cost Center

    CC002052 UMA CORP RC SBO Collections Unit CC

    Pay Rate Type

    Hourly

    Pay Grade

    Health-22

    Scheduled Weekly Hours

    40

    Work Shift

    Day (United States of America)

    Job Description

    Job Purpose: 

     

    This role will act as an internal liaison between the Medical University of South Carolina (MUSC) and Newby, Sartip, Masel & Casper, LLC (Commonly referred to as “Sartip”). This role support the vendor relationship by monitoring vendor contracts and monthly invoices. Create and maintain reporting of weekly incoming Sartip checks for the monthly Sartip Report.   

     

     

    Education and Work Experience

    §     High school diploma with four (4) years medically related customer service/collections experience, or bachelor’s degree and two (2) years medically related customer service/collections experience.   

    §     Knowledge of medical terminology and knowledge/understanding of health insurance preferred.  

    §     Must be proficient in Microsoft Word and Excel, with knowledge of Epic preferred;  

    §     Must be punctual and dependable, and have excellent interpersonal and oral and written communication skills.  

    §     Exhibit good organizational skills, strong initiative to be goal oriented. Establish and maintain effective relationships with necessary contacts. 

    §     Adheres to the MUSC Workforce standards of professional behavior and code of conduct.  

     

    Degree of Supervision  

    §     Must be able to work independently with minimum supervision.  Must exhibit the ability to analyze, and determine necessary steps to provide expected outcome and follow through with actions.  

     

     

     

    Licensures, Registrations, Certifications

    § N/A 

     

     

     

     

    Physical Requirements: 

    §     Continuous requirements are to perform job functions while standing, walking and sitting. Ability to bend at the waist, kneel, climb stairs, each in all directions, fully use both hands and legs, possess good finger dexterity, perform repetitive motions with hands/wrists/elbows and shoulders, reach in all directions. Maintain 20/40 vision corrected, see and recognize objects close at hand and at a distance, work in a latex safe environment and work indoors. Frequently list and/or carry objects weighing 20 lbs ( /-) unassisted. Lift from 36” to overhead 15 lbs. infrequently work in dusty areas and confined/cramped spaces.  

     

    Job Responsibilities: 

    60% 

    §  Manage a heavy volume of Legal Patient Accounts in an Epic work queue environment, the Legal Request mailbox, and One Content. 

    §  Effectively handle inbound and outbound legal calls/mail to and from attorney offices, third parties, and patients to resolve any legal issues related to probates, third party liability, workers compensation, bankruptcy, and settlement negotiations.   

    §  Accurately and consistently document all legal actions and conversations while complying with HIPAA privacy regulations and maintain compliance with federal and state laws and organizational policies.    

     

     

    20% 

    §  File Proof of Claims with Bankruptcy courts and monitor for status changes, including claim payments.   Receive and process requests for medical records, itemized statements, and subpoenas relating to current patients and legacy accounts. 

    §  Update patient demographics, insurance information, and guarantor information to maintain accurate patient information to ensure proper billing. 

     

    15% 

    §  Prepare legal checks for deposits from law firms by balance verifications and processing adjustments as needed.   

     

    5% 

    §  Other duties as assigned. 

    Additional Job Description

    Education and Work Experience:  Bachelors Degree with two (2) years medically related customer service/collections experience; or High School Diploma or equivalent with four (4) years medically related customer service/collections experience.

    If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

    The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

    Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees

  • 3 Days Ago

T
Office Specialist-Immediate start
  • TruGreen - Lawn Specialist
  • Summerville, SC FULL_TIME
  • TruGreen is Now Hiring Lawn Specialists!00 per Hour - Comprehensive Benefits 00 per hour Average income is $850 - $1,200 per week* - Based on hourly rate and average bonuses earned for qualifying spec...
  • 19 Days Ago

T
Office Specialist, Now Hiring
  • TruGreen - Lawn Specialist
  • Summerville, SC FULL_TIME
  • TruGreen is Now Hiring Lawn Specialists!00 per Hour - Comprehensive Benefits 00 per hour Average income is $850 - $1,200 per week* - Based on hourly rate and average bonuses earned for qualifying spec...
  • 19 Days Ago

C
Insurance Verification/Prior Authorization Specialist
  • Coastal Fertility Specialist
  • Daniel, SC FULL_TIME
  • Start a rewarding career that will last a lifetime! Coastal Fertility Specialists is growing and has an immediate opening for a Financial Counselor Assistant (Insurance Verification/Prior Authorizatio...
  • 2 Days Ago

C
Call Center Representative
  • Charleston Gastroenterology Specialist P
  • Summerville, SC FULL_TIME
  • Charleston GI has been developing since 1989, our practice is the first and largest gastroenterology practice in the Lowcountry to operate a physicians’ practice and three nationally certified and s...
  • 18 Days Ago

C
Fertility Nurse Coordinator
  • Coastal Fertility Specialist
  • Mount Pleasant, SC FULL_TIME
  • Start a rewarding career that will last a lifetime! Coastal Fertility Specialists is growing and has an immediate opening for a Registered Nurse who wants to make a difference in this world by helping...
  • 18 Days Ago

Filters

Clear All

  • Filter Jobs by companies
  • More

0 Appeal Resolution Specialist jobs found in Mount Pleasant, SC area

M
Wireless Sales Expert
  • MarketSource, Inc
  • Charleston, SC
  • Job Description The Wireless Sales Expert position will be working with America's #1 pre-paid wireless service provider....
  • 3/28/2024 12:00:00 AM

C
Subject Matter Expert III (SELC/SFLC)
  • Chugach Government Solutions, LLC
  • North Charleston, SC
  • Job Description Job Description The candidate will provide System Engineering Life Cycle (SELC), Surface Forces Logistic...
  • 3/26/2024 12:00:00 AM

M
Transplant Clinical Practice Nurse Expert
  • Musc
  • Charleston, SC
  • Job Description Summary The Transplant Clinical Practice Nurse Expert reports to the Transplant Operations Director. Und...
  • 3/26/2024 12:00:00 AM

Z
Customer Support Specialist - Work From Home>
  • Zip
  • Mount Pleasant, SC
  • [Customer Service / Fully Remote] - Anywhere in U.S. / Up to $75K per year / Full health, vision & dental / Apple equipm...
  • 3/24/2024 12:00:00 AM

Z
Customer Support Specialist - Work From Home>
  • Zip
  • Charleston, SC
  • [Customer Service / Fully Remote] - Anywhere in U.S. / Up to $75K per year / Full health, vision & dental / Apple equipm...
  • 3/24/2024 12:00:00 AM

T
FT Member Services Specialist - Work From Home>
  • Transcarent
  • Johns Island, SC
  • [Customer Service / Fully Remote] - Anywhere in U.S. / Up to $30 per hour / Medical, dental, and vision / 401k match / P...
  • 3/24/2024 12:00:00 AM

Z
Customer Support Specialist - Work From Home>
  • Zip
  • Goose Creek, SC
  • [Customer Service / Fully Remote] - Anywhere in U.S. / Up to $75K per year / Full health, vision & dental / Apple equipm...
  • 3/24/2024 12:00:00 AM

M
Transplant Clinical Practice Nurse Expert
  • MUSC
  • Charleston, SC
  • Job Description Summary The Transplant Clinical Practice Nurse Expert reports to the Transplant Operations Director. Und...
  • 2/21/2024 12:00:00 AM

Mount Pleasant is a large suburban town in Charleston County, South Carolina, United States. It is the fourth largest municipality and largest town in South Carolina, and for several years was one of the state's fastest-growing areas, doubling in population between 1990 and 2000. The population was 67,843 at the 2010 census,. The estimated population in 2014 was 77,796. At the foot of the Arthur Ravenel Bridge is Patriots Point, a naval and maritime museum, home to the World War II aircraft carrier USS Yorktown, which is now a museum ship. The Ravenel Bridge, an eight-lane highway that was c...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Appeal Resolution Specialist jobs
$45,103 to $55,873
Mount Pleasant, South Carolina area prices
were up 1.5% from a year ago

Appeal Resolution Specialist in Colorado Springs, CO
As a Appeals Resolution Specialist, you will work directly with our Shared Service Centerproviding follow up to denied claims.
February 22, 2020
Appeal Resolution Specialist in Fort Smith, AR
Overcome objections that prevent payment of the claim and gain commitment forpayment through concise and effective appeal argument.
February 01, 2020
Appeal Resolution Specialist in Middlesex, NJ
Coordinate the overall process of complaint resolution, responding to all verbal and written complaints from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, pharmacy and vision decisions.
January 25, 2020