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Medical appeals manager

Healthcare Financial

This is a Full-time position in Chicago, IL posted April 22, 2019.

Medical Appeals Manager will ensure all clinical appeals are being filed timely and appropriately, records are being requested from the client when appropriate, and that HIPAA is being followed. The Manager will write and submit medical appeals to insurance carriers.

The Manager will educate and support staff on a continual basis. The Manager will analyze the Department activities and recommend modifications to policy and procedures.

Essential :
· Understand all duties of the Medical Appeals Department
· Research and write medical appeals to be submitted in a timely manner
· Determine if medical appeal is appropriate action based on review of—and familiarity with—carrier clinical policy bulletins
· Train, educate and audit all staff in the Medical Appeals Department
· Ensure all policies and procedures are being followed
· Ensure goals are obtained
· Communicate accurately, diplomatically and professionally with employees and other Departments when issues arise or procedures need to be reviewed.
· Review written appeals for accuracy and professionalism
· Review appealed accounts to determine if the appeal was effective
· Make sure all requests for records are being completed within 7 working days
· Make sure all appeal requests are within 14 days from request
· Make sure appeals are not reaching timely filing
· Complete annual reviews
· Update ADP for payroll process
· Track employee PTO and absences
· Generate Medical Appeals, as needed, for but not limited to, medical necessity, non-emergent, experimental and retro authorization.
· Meet appeal filing deadlines by completing assigned work tasks in a timely matter
· Keep all patient health information (HIPAA) and other proprietary information confidential
· Notify Sr.

Management, the Compliance Officer and/or the Compliance Committee upon learning of any unauthorized disclosure or inappropriate use of confidential information (HIPAA)At least 3 years managing a group or processRelevant professional experience generating and working with medical appeals and/or letters of medical necessityEffective skills at managing a team, including development of staffKnowledge of how to operate basic computer functionsProficiency in MS Office applications (Excel, Word & Outlook) is requiredProficiency in reading, writing and arithmetic in order to investigate claims issues, appeal denied claims, and understand how to apply contract ratesMust demonstrate strong verbal and written communication skillsMust have strong analytical and troubleshooting skillsMust be a team playerAbility to handle multiple tasks at onceAbility to work efficiently, in an organized fashion, and meet daily and monthly department performance goalsMust possess good customer service skills Education:  Bachelor’s degree, Associates degree or relevant coursework ADDITIONAL NOTESThis position requires the employee to handle Protected Health Information (PHI).

Policies and Procedures will be strictly adhered to make sure PHI is protected as required by the HIPAA Privacy Rule.