Appeals Correspondence Specialist

Job Description:

Responsible for drafting, advancing, and maintaining all legal documents, letters and correspondence for appealing with third party and governmental payers to obtain reimbursement including handling difficult, hard to collect accounts that have been deemed by the insurance company to be unpayable.

Scope

This is a regional role reporting to the Manager of Appeals.

Job Essentials

1. Conducts analysis and resolves incorrect reimbursement issues with third party payers and recognizes when the account should become involved in a payment dispute with the insurance company.

2. Conducts research and formulates a defense to support appeals with insurance companies and other payers as needed. Strategizes which appeal strategy should best be used (medical necessity, payer language, state/federal laws).

3. Maintains an understanding of expected reimbursement information and legal parameters pertaining to all State, Federal, SelfFunded and ERISA regulations.

4. Provides education and training to department staff on strategies to be used with appeals. Also educates them on the correct application and interpretation of insurance law. Updates new employees on regulations and policies and procedures surrounding appeals.

5. Drafts, advances, and maintains all legal/technical documents, letters, and correspondence pertaining to all level of appeals.

6. Responsible for formulation, implementation, and maintenance of a procedures manual/document that encompasses the guidelines relating to the purpose of the Centralized Appeals Unit.

7. Serves as a subject matter expert, resource, and mentor to others within the RCO, clinical departments, Appeal RN’s, legal, IPAS and Payor Contracting on the art of appealing.

8. Works closely with appeal specialists in obtaining all pertinent information required for appeal letter

Minimum Requirement

Two (2) years of experience in English Writing/Health Insurance, Public Relations or related fields. Demonstrated knowledge of the health insurance industry is required. Demonstrated knowledge of all state/federal laws that relate to insurance contracts and the appeal process is required.

Preferred Qualifications

Bachelor’s Degree (BSN) is preferred.

Knowledge, Skills, Abilities

Speaking, hearing / listening, seeing, manual dexterity.

Extensive knowledge of insurance appeal process.

Must exhibit exemplary written, oral, and visual communication skills.

Knowledge and ability to use conflict resolution skills to build cohesive teams

Physical Requirements:

Location:

Lake Park Building

Work City:

West Valley City

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$26.84 – $42.28

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

All positions subject to close without notice.