Strategic Appeal Specialist - Financial Clearance Center

Location: METROHEALTH MEDICAL CENTER

Biweekly Hours: 80.00

Shift: 8:00am

The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.

Summary:


Processes both inpatient and outpatient denials and appeals while following departmental and federal/state/other regulatory agencies' requirements. Follows up on internal and external status inquiries. Produces/distributes denial and appeal statistics through regular reporting. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.

Qualifications:

Required:

Meets one of the following:
  • Associate's degree from an accredited institution.
  • 3 years of hands-on experience with processing and/or following up on insurance denials and appeals will be accepted in lieu of a degree.
Strong PC skills. Experience with and/or a strong understanding of managed care information systems.
Strong written, verbal, and interpersonal communication skills.
Solid organizational skills. Ability to work independently, and in a team environment.
Ability to work with a high degree of flexibility.

Preferred:

  • Experience with Epic.
  • Experience using MIDAS+ products.


Physical Requirements: May sit, stand, stoop, bend, and ambulate intermittently during the day. May need to sit or stand for extended periods. See in the normal visual range with or without correction. Hear in the normal audio range with or without correction. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Ability to communicate in face-to-face, phone, email, and other communications. Ability to see computer monitor and departmental documents.