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Title

Appeals and Denials Claims Representative 

EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.  
Description

MedData has an excellent career opportunity available as an Appeals & Denials Claims Rep to work in our beautiful Draper, UT office.. The schedule for this full time role is Monday- Friday 7am -3:30pm. The schedule may vary at times due to client needs and coverage. 

 

**We are looking for individuals that have great customer service skills, excellent Microsoft office skills (Word, Excel and Outlook), a knack for problem solving, a sense of urgency and excellent communication skills. Previous call center exp a plus!

Do you consider yourself to have a...

  • Positive and encouraging attitude
  • Strong customer service background
  • Professional, accurate, clear and concise communication

Are you...

  • Detailed and thorough
  • Adaptable

If so, you may be just what we are looking for!

POSITION OVERVIEW:

The purpose of this position is to assist hospitals and providers in resolving accounts that are denied and need information from the patient who has been unresponsive to the hospital/providers attempts to secure the needed information. Specifically, this position is focused on the effort to obtain the necessary forms, documents, responses from the patient, hospital, employer and from other sources (including telephone, mail, email and fax), resubmission of insurance bills and appeals to insurance carriers.  Unresponsive Patient Denial Claims Specialists facilitate patients and insurances to ensure proper claim processing for resolution.

 

ESSENTIAL JOB FUNCTIONS:  

  • Maintain a queue of Unresponsive Patient Denial accounts as assigned by management
  • Maintain quality and productivity levels set by management, once full job proficiency has been achieved.
  • Contact patient’s employer, insurance carriers and patient via telephone and mail to obtain required information for denied claims.
  • Review and research insurance carriers to determine accurate payer order 
  • Ensure that patients properly update necessary information according to payer and project specific guidelines
  • Investigate and work with patients to correctly update necessary information and documentation with their insurance carriers
  • Support patients by answering any questions about the insurance process related to their account.
  • Coordinates with appropriate client personnel to ensure appropriate filing guidelines are met for reimbursement. 
  • Requests appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition. 
  • Perform manual data entry of patient accounts and/or claim forms
  • Resubmit hospital and physician bills to insurance companies for payment.
  • Maintain contact with insurance adjusters/carriers, employers and patients during the claim adjudication process to ensure that the hospital and physician bills are paid timely and in full.
  • Responsible for obtaining claim status and gathering supporting documentation to submit appeals
  • Provide strong customer service to clients and provide responses to client inquiries within 24 hours.
  • Provide detailed updates to MedData’s account management system and hospital/provider practice management system as account work is completed.
  • Assist in training both new and existing employees, which may include contributing specific training material.
  • Escalate complex, complicated or challenging accounts to management to ensure accounts are progressing effectively.
  • Identify and discuss root cause issues with management.
  • Maintains and updates proper account documents in multiple systems.
  • Assist management with adhoc inventory initiatives and other projects, as needed
  • Makes written or verbal appeals to payers on denied claims. 

 

QUALIFICATIONS: 

  • High School Diploma or GED
  • Some college coursework preferred
  • Ability to communicate effectively verbally and in writing and be able to speak professionally with patients and insurance companies
  • Proven ability to be assertive in order to critical think and proactively resolve issues
  • Demonstrate ability to organize and set priorities according to situation all demands
  • Excellent customer service skills 
  • Must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, understand how to navigate through web-based applications, and the ability to learn in-house computer applications
  • Positive team player attitude and mindset
  • 0-1 years of related experience in the field or in a related area  

BENEFITS:

MedData believes in making a positive impact not only within our industry but also with our employees –the organization’s greatest asset. We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.

Just some of the benefits we offer:

  • Medical
  • Dental
  • Vision
  • HSA, FSA
  • 401K
  • Paid Time Off

 

???????This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.

  

To join our team of 2,000 employees and growing, please apply directly to this posting. 

 

MedData is an Equal Opportunity Employer

 
Full-Time/Part-Time Full-Time  
Shift Days  
Req Number HEA-21-00181  
About the Organization MedData is a healthcare revenue cycle management services provider with more than 40 years of experience. We offer hospitals and health systems a full complement of solutions, including eligibility & enrollment, accounts receivable management & recovery, self-pay/early out, and denials management. We currently serve nearly 2000 facilities nationwide from our headquarters in Houston and more than 20 regional offices across the United States.



At MedData, we take great pride in our company, in each other, and in our 40+ year history of accomplishments and success. This pride is reflected in our everyday approach to working together. Each team member understands the importance of being part of a company that values their individual contributions and strives to help them achieve their personal goals as they work together to achieve the broader corporate goals. We believe that every team member contributes directly to MedData's growth and success, and we are constantly searching for new talented, passionate and enthusiastic people who will take pride in being an integral part of our culture.  

This position is currently not accepting applications.

To search for an open position, please go to http://MedData.appone.com


 


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