APPEALS SPECIALIST - TMC BONHAM (PRN)

TMC Bonham Hospital is a 25-bed critical access hospital that includes both primary care and specialty physicians. The Critical Access Hospital, offering both inpatient and outpatient services along with 24-hour emergency services. The Critical Access Hospital (CAH) Program was established to assure access to healthcare services for rural residents. The program provides rural acute care hospitals with a range of opportunities for service enhancement and quality of care improvement. Quality healthcare and patient safety is our goal. Delivering the right care at the right time in the right setting is the core mission of a critical access hospital. We are committed to improve the quality of care we deliver every day. TMC Bonham is managed by Texoma Medical Center, subsidiary of UHS.

The Appeals Specialist is responsible for appealing all insurance denials and prepare relevant reports regarding trends in denials. Demonstrate the ability to ensure accurate and timely appeals to third party payers in compliance with Managed Care contracts and government fee schedules. The Appeals Specialist will obtain, manipulate, and analyze data from a variety of resources including but not limited to hospital/physician billing systems, external contract/claims management and work with departmental personnel.

Certification in medical coding and billing preferred.

2-3 years of experience in customer service, healthcare appeals processing or insurance industry

Must possess a strong knowledge of clinical documentation, Medicare rules and regulations; excellent interpersonal communication and problem solving skills necessary to gather and exchange data ( both internally and externally) with key medical and third party professionals; experience with Microsoft Office and internet websites.

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