Remote Medical Appeals Specialist - Expert in Denial Management and Healthcare Revenue Cycle Optimization

Transform Your Career with a Leading Healthcare Provider

At Community Health Systems, we're dedicated to helping people get well and live healthier. As one of the nation's leading healthcare providers, we operate 71 acute-care hospitals and over 1,000 other sites of care across 15 states. Our commitment to delivering high-quality, patient-centered care is at the heart of everything we do. We're now seeking a skilled Remote Medical Appeals Specialist to join our team and play a vital role in driving our mission forward.

About the Role

As a Remote Medical Appeals Specialist at Community Health Systems' Shared Services Center, you'll be responsible for reviewing and resolving pre-pay insurance denials, collaborating with cross-functional teams, and driving process improvements to optimize denial management and appeals. This is a fantastic opportunity to leverage your expertise in healthcare revenue cycle management and make a meaningful impact on our organization.

Key Responsibilities

• Denial Review and Resolution: Review and resolve pre-pay insurance denials, correlating with follow-up teams to ensure timely and effective resolution (20%).
• Collaboration and Education: Work closely with Denial Coordinators, Facility Denial Liaisons, and Managed Care Coordinators to educate and hold payers accountable (20%).
• Process Improvement: Consult with managers and staff to identify developmental needs for new processes and make recommendations for change (20%).
• Knowledge Maintenance: Stay up-to-date on practice management systems, basic coding and billing knowledge, customer service techniques, basic insurance/carrier knowledge, and front office operation policies (20%).
• Resource Development: Gather and make available educational resources to support denial/appeal management processes and collaborate with associates and departments to drive understanding and improvement (20%).

Essential Qualifications

To succeed in this role, you'll need:

• 1+ year of experience in a healthcare revenue cycle setting, with a strong understanding of denial management and appeals processes.
• Excellent analytical and problem-solving skills, with the ability to interpret complex data and make informed decisions.
• Strong communication and collaboration skills, with the ability to work effectively with cross-functional teams and stakeholders.
• Basic knowledge of coding and billing principles, as well as insurance/carrier knowledge and front office operation policies.

Preferred Qualifications

While not required, the following qualifications can give you a competitive edge:

• 1+ year of experience in healthcare revenue cycle setting including chart review and denial processing, with a proven track record of driving process improvements.
• Experience with practice management systems, with a strong understanding of their application in denial management and appeals.

Skills and Competencies

To excel in this role, you'll need:

• Strong analytical and critical thinking skills, with the ability to analyze complex data and make informed decisions.
• Excellent communication and interpersonal skills, with the ability to work effectively with diverse stakeholders.
• Ability to work in a fast-paced, dynamic environment, with a strong focus on attention to detail and accuracy.
• Strong problem-solving and conflict resolution skills, with the ability to navigate complex issues and drive resolution.

Career Growth Opportunities

At Community Health Systems, we're committed to supporting the growth and development of our team members. As a Remote Medical Appeals Specialist, you'll have opportunities to:

• Develop your skills and expertise in denial management and appeals, with access to training and professional development resources.
• Advance your career within our organization, with opportunities for promotion and career progression.
• Collaborate with cross-functional teams, driving process improvements and contributing to the success of our organization.

Work Environment and Culture

As a Remote Medical Appeals Specialist, you'll be part of a dynamic and supportive team that values:

• Flexibility and work-life balance, with a flexible, hybrid remote work arrangement.
• Collaboration and teamwork, with opportunities to work with diverse stakeholders and drive process improvements.
• Professional development and growth, with access to training and career advancement opportunities.

Compensation and Benefits

We offer a comprehensive total rewards package, including:

• Competitive salary, reflecting your experience and qualifications.
• Robust benefits package, including health insurance, flexible scheduling, 401k, and student loan repayment programs.
• Opportunities for career advancement and professional growth, with a commitment to supporting your long-term success.

Join Our Team

If you're a motivated and experienced professional looking to make a meaningful impact in healthcare, we encourage you to apply for this exciting opportunity. As a Remote Medical Appeals Specialist at Community Health Systems, you'll play a vital role in driving our mission forward and contributing to the success of our organization.

Take the first step towards a rewarding new role - apply now!