Corporate Appeals Specialist
Company: Neuropsychiatric Hospitals
Posted on: November 15, 2021
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
- 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
- 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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