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Licensed Appeal Writer - Remote
<p style="margin: 0; font-size: 12pt; font-family: 'Times New Roman', serif;"><span style="font-size: 10pt; color: rgba(0, 0, 0, 1); font-family: Montserrat;"><strong>Job Purpose</strong></span></p> <p style="margin: 0; font-size: 12pt; font-family: 'Times New Roman', serif;"><span style="font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);">The Licensed Appeal Writer supports the Company by reviewing insurance claims denied for payment on behalf of our client hospitals. Working closely with nurses and other team members, the Licensed Appeal Writer creates appeal letters in support</span></p> <p style="margin: 0; font-size: 12pt; font-family: 'Times New Roman', serif;"> </p> <p style="margin: 0; font-size: 12pt; font-family: 'Times New Roman', serif;"><span style="font-size: 10pt; color: rgba(0, 0, 0, 1); font-family: Montserrat;"><strong>Duties & Responsibilities</strong></span></p> <p style="margin: 0 0 0 0.5in; font-size: 11pt; font-family: Calibri, sans-serif;"> </p> <ul style="margin-bottom: 0; margin-top: 0;"> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Review denied insurance claims</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Review patients’ medical files</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Develop strategies to reverse claim denials</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Create written appeals</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Manage and organize appeal workflow based on internal, client-based, and insurance-driven deadlines</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; background-color: rgba(255, 255, 255, 1); line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text;">Other duties as assigned</span></span><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; background-color: rgba(255, 255, 255, 1); line-height: 16px;"> </span></span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards</span></li> </ul> <ul style="margin-bottom: 0; margin-top: 0;"> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Understand and comply with Information Security and HIPAA policies and procedures at all times</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties</span></li> </ul> <p style="margin: 0; font-size: 11pt; font-family: Calibri, sans-serif;"> </p> <p style="margin: 0; font-size: 11pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; color: rgba(0, 0, 0, 1); font-family: Montserrat;"><strong>Qualifications</strong></span></p> <p style="margin: 0 0 0 0.5in; font-size: 11pt; font-family: Calibri, sans-serif;"> </p> <ul style="margin-bottom: 0; margin-top: 0;"> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">4-year degree or work equivalency required</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Must hold an active license as a Physician's Assistant (PA), Registered Nurse (RN), Nurse Practitioner (NP), Licensed Practical Nurse (LPN), Physical Therapist (PT), Occupational Therapist (OT), or an equivalent professional license</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Must be able to prioritize workload based on strict deadlines</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Must be tech-savvy with ability to quickly learn new software</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Must possess a high level of reading comprehension and ability to analyze medical information and terminology</span></li> </ul> <ul style="margin-bottom: 0; margin-top: 0;" type="disc"> <li style="color: rgba(0, 0, 0, 1); background: rgba(255, 255, 255, 1); margin-top: 0; margin-right: 0; margin-bottom: 0; font-size: 10pt; font-family: Montserrat;"><span style="font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);">Proficiency in Microsoft Office Suite</span></li> <li style="color: rgba(0, 0, 0, 1); background: rgba(255, 255, 255, 1); margin-top: 0; margin-right: 0; margin-bottom: 0; font-size: 10pt; font-family: Montserrat;"><span style="font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);">Strong interpersonal skills, ability to communicate well at all levels of the organization</span></li> <li style="color: rgba(0, 0, 0, 1); background: rgba(255, 255, 255, 1); margin-top: 0; margin-right: 0; margin-bottom: 0; font-size: 10pt; font-family: Montserrat;"><span style="font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);">Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses</span></li> <li style="color: rgba(0, 0, 0, 1); background: rgba(255, 255, 255, 1); margin-top: 0; margin-right: 0; margin-bottom: 0; font-size: 10pt; font-family: Montserrat;"><span style="font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);">High level of integrity and dependability with a strong sense of urgency and results oriented </span></li> <li style="color: rgba(0, 0, 0, 1); background: rgba(255, 255, 255, 1); margin-top: 0; margin-right: 0; margin-bottom: 0; font-size: 10pt; font-family: Montserrat;"><span style="font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);">Excellent written and verbal communication skills required</span></li> <li style="color: rgba(0, 0, 0, 1); background: rgba(255, 255, 255, 1); margin-top: 0; margin-right: 0; margin-bottom: 0; font-size: 10pt; font-family: Montserrat;"><span style="font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);">Gracious and welcoming personality for customer service interaction</span></li> </ul> <p style="margin: 0; font-size: 11pt; font-family: Calibri, sans-serif;"> </p> <p style="margin: 0; font-size: 11pt; font-family: Calibri, sans-serif;"> </p> <p style="margin: 0; font-size: 11pt; font-family: Calibri, sans-serif;"><span style="font-size: 10pt; color: rgba(0, 0, 0, 1); font-family: Montserrat;"><strong>Working Conditions</strong></span></p> <ul style="margin-bottom: 0; margin-top: 0;" type="disc"> <li style="color: rgba(0, 0, 0, 1); background: rgba(255, 255, 255, 1); margin-top: 0; margin-right: 0; margin-bottom: 0; font-size: 10pt; font-family: Montserrat;"><span style="font-size: 10pt; color: rgba(0, 0, 0, 1); font-family: Montserrat;"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text;">Must</span><span style="margin: 0; padding: 0; user-select: text;"> </span><span style="margin: 0; padding: 0; user-select: text;">possess</span><span style="margin: 0; padding: 0; user-select: text;"> a </span><span style="margin: 0; padding: 0; user-select: text; background-position: left bottom; background-repeat: repeat-x; border-bottom: 1px solid rgba(0, 0, 0, 0);">smart-phone</span><span style="margin: 0; padding: 0; user-select: text;"> or electronic device capable of downloading applications, for multifactor authentication and security purposes.</span></span><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"> </span></span></li> <li style="color: rgba(0, 0, 0, 1); background: rgba(255, 255, 255, 1); margin-top: 0; margin-right: 0; margin-bottom: 0; font-size: 10pt; font-family: Montserrat;"><span style="font-size: 10pt; color: rgba(0, 0, 0, 1); font-family: Montserrat;"><em>Physical Demands: </em>While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.</span></li> <li style="color: rgba(0, 0, 0, 1); background: rgba(255, 255, 255, 1); margin-top: 0; margin-right: 0; margin-bottom: 0; font-size: 10pt; font-family: Montserrat;"><span style="font-size: 10pt; color: rgba(0, 0, 0, 1); font-family: Montserrat;"><em>Mental Demands:</em> The employee must be able to follow directions, collaborate with others, and handle stress.</span></li> <li style="color: rgba(0, 0, 0, 1); background: rgba(255, 255, 255, 1); margin-top: 0; margin-right: 0; margin-bottom: 0; font-size: 10pt; font-family: Montserrat;"><span style="font-size: 10pt; color: rgba(0, 0, 0, 1); font-family: Montserrat;"><em>Work Environment: </em>The noise level in the work environment is usually minimal.</span></li> </ul> <p style="margin: 0; font-size: 12pt; font-family: 'Times New Roman', serif;"> </p> <p style="margin: 0; font-size: 12pt; font-family: 'Times New Roman', serif;"> </p> <p style="margin: 0; font-size: 12pt; font-family: 'Times New Roman', serif;"><span style="font-size: 10pt; color: rgba(0, 0, 0, 1); font-family: Montserrat;"><em><span style="background: rgba(255, 255, 255, 1);">Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.</span></em></span></p>
