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Corporate Appeals Specialist

Company: Neuropsychiatric Hospitals
Location: Greenwood
Posted on: November 15, 2021

Job Description:

About Us:HEALING THE BODY AND MINDFounded fifteen (15) years ago, NPH is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We are unique in that we serve a population which others have been previously been unable to, largely due the patient's underlying medial issues. Our facilities maintain an inter-disciplinary focus using a multi-specialty approach for both neuropsychiatric and complex medical care issues. This proven approach provides unrivaled quality care for all of our patients. We have multiple locations throughout the United States and are continuing to add locations to ensure better access to our unique model of care.Overview:Neuropsychiatric Hospitals is looking for a Corporate Appeals Specialist to work out of our Hospital in either Indianapolis, IN or Greenwood, IN!.Responsibilities:Responsibilities include but are not limited to:

  • The receipt of appeals, data entry into an electronic system in real time, facilitating external review by vendors, and timely case completion. Enters denials and requests for appeal into information system and prepares documentation for further review. Researches issues utilizing knowledge in the decision-making process regarding health care services, and care provided.
  • Assure timeliness, and appropriateness of all Provider appeals according to each carrier's guidelines. Evaluates for medical necessity and appropriate levels of care and formulates conclusions timely.
  • Collaborates with Medical Directors and other team members to determine appropriate responses timely. Speak to providers and members regarding the appeal process, as well as status of appeals timely. Answer and triage the appeal phone calls timely.
  • Collaborate with both internal and external personnel to ensure that appeals are being processed adhering to the carrier's guidelines. Update authorizations based on outcome of appeals promptly. Collaborate with internal personnel to ensure that they are notified of the Appeal outcome timely.
  • Request and obtain medical records, notes, and/or detailed bills as appropriate, and timely to assist with research.
  • Ensure all documentation regarding the appeals process is documented in the electronic system in real time. Ensure all appeals are properly logged in real time updating daily.Ensure all appeals are sent to the carrier by the deadline by either mail or fax following the carrier's instructions.
  • Ensure all appeals are followed up on in a timely manner.
  • Must be willing, able to travel to and from our Hospital locations in Indianpolis and Greenwood, IN.Qualifications:Education: High School Diploma or GEDLicensure/Certification Requirements: College Degree or Medical Assistant preferredExperience Requirements: Two (2) years Office, Billing, Insurance or Appeals experience#INDEEDMED

Keywords: Neuropsychiatric Hospitals, Greenwood , Corporate Appeals Specialist, Other , Greenwood, Indiana

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