Job Description

This is a Remote position

About Zealie

Zealie is a fast-growing Medical Billing Services company specializing in the Behavioral Healthcare industry. Our clients are substance use disorder treatment, addiction recovery, and mental health treatment centers that are saving lives on a daily basis. Our state of the art proprietary technology provides data analytics and revenue prediction tools to our clients to help them make strategic business decisions to grow their business. We are committed to delivering exceptional products and services to our clients and believe that our Utilization Review team plays a crucial role in achieving this mission. We are seeking motivated individuals with a desire to be a part of a winning team.

Job Summary

The Medical Records Appeals Specialist is responsible for managing and maintaining patient records and ensuring their accuracy, completeness, and confidentiality. This role involves organizing and maintaining and filing appeals with medical files and processing patient information. This position involves extensive EHR portal access and direct contact with insurance companies to follow up on status of appeals sent. The Medical Records Appeals Specialist will analyze all aspects of the claim and identify any medical record discrepancies from codes billed, authorizations, documentation and communicate with necessary parties in a timely manner.

Responsibilities and Duties

Retrieve and prepare appeals for healthcare providers, insurance companies, or legal entities as requested. Prepare regulatory agency complaints Prepare external reviews Review patient records for completeness and accuracy, and ensure all required documentation is present. Cross reference billing and authorization software to ensure accuracy in billing submissions prior to submitting medical records Ensure that all appeals are compliant with healthcare regulations, including HIPAA and other relevant laws and standards. Enter and analyze data in Google spreadsheets and payer portals Prepare and submit correspondence such as emails and online inquiries Maintain regular contact with necessary parties, including Team Leads, Managers, and other personnel, regarding claims status, discrepancies and/or adjustments. Maintain or exceed the daily goal for accounts worked Answer calls, voicemail and correspondence within department for account resolution Maintains confidentiality of all pertinent patient care information to assure patient rights are protected Other duties as assigned

Qualifications and Skills

Excellent organizational skills Strong AR experience Ability to critically think Strong attention to detail and accuracy. Experience working with Payer portals Effective communication skills, both verbal and written via phone and email Proficiency in EHR systems and standard office software including Google Workspace, Google Drive, Google Sheets, Google Docs Ability to navigate various technology and software tools Ability to work independently and as part of a team Ability to manage multiple tasks and priorities in a fast-paced environment

Education and Experience

High school diploma or equivalent required; Associate's degree in Health Information Management, Medical Records, or a related field preferred Previous experience in an appeal setting, medical records or health information role is advantageous. Experience with electronic health record (EHR) systems is highly desirable.

(Preferred):

Experience working in a behavioral health billing setting * Knowledge of Substance Abuse/Mental Health Treatment Industry