Apply on Employer Site

Compass Revenue Solutions · 2 months ago

MR & Appeal Specialist I

Peachtree City,GA,US

Full-time

Onsite

Entry Level

2+ years exp

Compass Revenue Solutions is focused on optimizing revenue recovery through effective management of medical records and appeals. The Medical Record & Appeal Specialist is responsible for tracking appeal statuses, ensuring compliance with healthcare regulations, and enhancing the efficiency of appeal processes.

Financial ServicesFinTechInsurance

Responsibilities

Systematically monitoring the status of submitted appeals, identifying pending claims and timelines for follow-up in the billing system and Monday.com

Initiating and conducting consistent follow-up communication with insurance payers to ascertain appeal adjudication status, resolve outstanding issues, and expedite payment resolution

Facilitating the resolution of appeal denials through persistent follow-up and escalating complex or unresolved cases to appropriate internal or external parties

Ensuring all follow-up activities adhere to current healthcare regulations, coding guidelines, and payer policies

Accurately documenting all follow-up actions, communications, and appeal outcomes; generating comprehensive reports on follow-up effectiveness and trends

Analyzing follow-up processes to identify and implement improvements that enhance efficiency and maximize revenue recovery from appealed claims

Qualification

EMR platformsRegulatory requirementsMedical records experienceAnalytical thinkingDocumentation accuracyProcess optimizationTime managementCommunication skills