Appeals Negotiator - Phoenix, AZ
- - 3625F - Admin-FIN-EMS-Mgmt
- Phoenix, AZ, USA
- Full Time
The appeals negotiator is responsible for ensuring the highest reimbursement for all underpaid contractual and non-contractual payers. The negotiator will build and maintain outstanding relationships with all payers while adhering to PHI reimbursement policies. The negotiator will identify, document, and assist in the collections of all contracted and non-contracted underpayments from the payers. The negotiator will provide and produce thorough supporting documentation regarding additional payment for the level of services that were rendered. This position provides oversight and resolution for claim denials that require written response. This includes denials for medical necessity, low "usual and customary" payments, not to the closest facility, and reduction to ground level payments. This position requires a high level of knowledge in compliance, federal and state regulations, and clinical record information extraction. This position reports to the leadership of Patient Financial Services.
- 5 & 2
- High School diploma or GED required.
- Bachelor's degree preferred with 5 years related work experience.
- 5+ years' experience in medical billing, surgical billing, billing in emergency medical services and collections preferred.
- Medicare, Managed Care, Workers' Comp. experience.
- 3-5 years of experience in appeals and negotiation background.
- Expertise in billing software and Internet-based research required.
- Must have solid knowledge of patient account systems, revenue management processes, workflow systems and the ability to troubleshoot and suggest improvements.
- Ability to work independently with strong interpersonal skills to effectively interact with all levels of employees both with the client and with PFS.
- Must have demonstrated experience in researching statutes and understanding regulatory documents.
- Must demonstrate the ability to draft a professional and effective appeal letter.
- Ability to verbally communicate details and understand parameters of job responsibilities.
- Ability to provide written communication using best business practices when composing letters, memorandums, and e-mails regardless if the communication is inside the Company or with customers, clients, or providers.
- Ability to read, write and follow specific instructions in both written and verbal form.
- Requires an in-depth understanding of compliance, regulatory oversight bodies and payer requirements.
- Team player, interfaces well with employees.
- Represents the company in a positive, customer friendly attitude to other employees, clients, agencies, entities and patients.
- May have supervisory responsibility.
- This position is designated Safety Sensitive for purposes of the Arizona Medical Marijuana Act.
- Base salary
- Safe. We are absolute in our belief in the tenets of Destination Zero and that Zero is not only achievable, but the only acceptable outcome.
- Efficient. We are focused on outcomes that are smart and responsible by making the best use of our resources to maximize overall productivity and achieve sustainable profitability as a high performing organization.
- Quality. We are committed to ensuring excellent organizational performance which produces sustainable and reliable outcomes.
- Service. We are dedicated to the service of our customers, our communities and each other.
- Team Player - Effective performers are team oriented. They identify with the larger organizational team and their role within it. They share resources, respond to requests from other parts of the organization, and support larger legitimate organizational agendas as more important than local or personal goals.
- Positive Impact- Effective performers make positive impressions on those around them. They are personable, self-confident, and generally likable. They are optimistic and enthusiastic about what they do, and their excitement is contagious. They energize those around them.
- Mission Focus- Effective performers understand and support the organization's mission - its core purpose for being. They believe in the mission, value it, and are committed to it. They communicate it to staff, stand behind it, and interpret its applications for others. They frequently refer to the mission and incorporate it into daily activities.
- Conflict Management- Effective performers recognize that conflict can be a valuable part of the decision-making process. They are comfortable with healthy conflict, and they support and manage differences of opinion. They thwart destructive competition or friction and use consensus to debate and resolve issues.
- Problem Solving & Decision Making- Effective performers are able to identify problems, solve them, act decisively, and show good judgment. They isolate causes from symptoms, and compile information and alternatives to illuminate problems or issues. They involve others as appropriate and gather information from a variety of sources. They find a balance between studying the problem and solving it. They readily commit to action and make decisions that reflect sound judgment.
Hiring Manager: Martha Greer