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Appeals Contact Specialist

Location: Pittsburgh, PA

Cardiac Management Solutions

 

The Cardiac Management Solutions division of ZOLL Medical Corporation develops products to protect and manage cardiac patients, including the LifeVest® wearable cardioverter defibrillator (WCD), the ZOLL cardiac monitor, and associated technologies.

Heart disease is the leading cause of death for both men and women in the U.S. At ZOLL, your work will help to ensure cardiac patients get the life-saving therapy they need. To date, the LifeVest WCD has been worn by hundreds of thousands of patients and saved thousands of lives.

ZOLL has been Pittsburgh’s Manufacturer of the Year, one of Western PA’s Healthiest Employers, and even one of Pittsburgh’s Coolest Offices. But it’s our unique opportunity to impact people’s lives that makes ZOLL the ideal place to build your career.

Position Summary:  The Appeals Contact Specialist is responsible for interacting with insurance carriers to both verify appeals status and provide all necessary information required for the payer to issue a decision in respect to appeals filed by ZOLL.  

Essential Duties and Responsibilities:

  • Utilize LVN Reports to identify appeals that have been sent to various insurance carriers

  • Contact insurance carriers to verify appeal review status

  • Re-bill claims and/or re-send appeals that are lost by insurance carriers and provide substantiating documentation if necessary

  • Obtain necessary documentation (updated medical order, clinical notes, patient agreement, etc.) and submit to insurance carriers to effect review and decision of appeal

  • Contact patients, physician offices, and territory managers to relay and/or obtain pertinent information and/or documents to effect review and decision of appeal

  • Support the Appeals Coordinator by auto generating template appeal letters for select insurance carriers

  • Perform other duties as assigned by Management

Supervisory Responsibilities:  None.

Qualifications:  To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skills and abilities required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job.

Educations and/or Experience:

  • H.S. Diploma or equivalent required.

  • Customer Service experience required.

  • Collections experience preferred.

  • 1 year of payer and clinical criteria experience

  • Persuasive negotiation and time management skills

  • Knowledge of all payer types, to include Medicare, Medicaid, and third party commercial insurance companies preferred

  • Proficiency in MS Office.

Language Skills:  Ability to read and comprehend instructions, correspondence, and memos.  Ability to write correspondence and be persuasive.  Ability to effectively present information in one-on-one and small group situations to customers, clients, payers and other employees of the organization.

Mathematical Skills:  Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability:  Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Ability to deal with problems involving several concrete variables in standardized situations.

Physical Demands: 

  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to walk. The employee must occasionally lift and/or move up to 10 pounds.

Work Environment:

  • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • The noise level in the work environment is usually quiet.

 

Equal Opportunity Employer-Disability and Veteran

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