Physician Billing Appeals Specialist

York, PA | Clerical and Administrative | Tracking Code: 50626

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General Summary:
Under general supervision, monitors contractual allowances and analyzes and pursues appeal opportunities with payers and networks. Represents the System in a professional manner, using good customer service practices in the performance of all duties.

Duties and Responsibilities:

1 Uses the Experian CM application to identify variances and track appeals & recoveries.
2 Implements process for identifying under and over allowances on claims.
3 Reviews and analyzes EOBs for identified under and/or over allowances.
4 Compiles and submits appeals by written appeal, telephone appeal, online appeal or by batch appeal to provider rep.
5 Establishes appropriate contacts and follow up protocol with payers and networks.
6 Maintains contracted rates in the Experian CM application.
7 Discusses ongoing trends and issues regarding payment variances with management and staff.
 

 

Required Skills

Medical Terminology Preferred

ICD 9 & CPT Coding Knowledge Preferred

Health Insurance Knowledge Preferred


Quality of Life

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 1,200 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, six respected hospitals, more than 15,000 employees, and 140 patient care locations. WellSpan is a charitable, mission-driven organization, committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Quality of Life
Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)

Equal Opportunity Employment

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

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