Non-Clinical Careers at Lifespan

Appeals Specialist Job

Job Number: LCS18560

Job Title: Appeals Specialist

Department: Third Party Follow-Up - 0014661

Facility: Corporate Headquarters

Location: Providence, RI


The Appeals Specialist reports to the Manager of Clinical Appeals. Under general direction and within established Lifespan policies and procedures, maximizes reimbursement from contracted payers through analysis, tracking and trending of clinical appeals using available metric appeal/denial reports. Responsible for actively supporting the execution of strategic initiatives, process re-design, root cause analysis, metric/report development, and special projects as it relates to Clinical Appeals. Executes the appeal process by receiving, assessing, documenting, tracking, analyzing, responding to, and and/or resolving appeals with third-party payers.

BASIC KNOWLEDGE:

Associate’s degree in accounting, business office practices, computer science or other related area or equivalent experience.

EXPERIENCE:

Three to five years’ experience in hospital patient accounting. Experience should demonstrate thorough knowledge of claims administration in similarly complex healthcare organization. Must be familiar with ICD-9/10, CPT-4 coding, UB04 and HCFA 1500 claims administration. Ability to perform financial analysis. Comprehensive knowledge of patient accounting activities in an automated, networked, multiple hospital environment. Detailed knowledge of regulatory requirements