Appeals Specialist – Peer to Peer

Commitment: Full-Time | Candidates must be able to work between the hours of 11 am to 8 pm ET

Office Location: Onsite positions in Newtown Square, PA. (Remote position during Covid-19)

About Versalus Health

Versalus Health is an innovative, rapidly growing physician-led organization that helps hospitals improve financial performance by benchmarking hospital performance by payer and functional area, identifying sources of lost revenue or risk, creating and implementing operational solutions to address the issues uncovered, and monitoring ongoing results. The company has a vibrant culture that strives to promote a positive work-life balance while allowing professionals to utilize their skills in an environment that positively impacts healthcare.

 Job Description and Responsibilities:

  • Interact with payers and hospital clients over the phone and electronically to validate and schedule Peer to Peer requests
  • Perform denial research and follow-up work with insurance companies via phone to resolve written appeal submissions which remain without a determination
  • Extract data through multiple systems
  • Support various functions within the department such as case entry support and Appeals support
  • Perform other duties as assigned

Skills: 

  • Comfortable communicating with others over the phone
  • Strong verbal and written communication skills
  • Detail-oriented
  • Extremely organized and action-oriented
  • Works independently, but is a team player
  • Able to work in a fast-paced environment
  • Required to keep all client and sensitive information confidential
  • Strict adherence to HIPAA/HITECH compliance

Education/Experience Required: 

  • High School Diploma or equivalent required. Bachelor’s degree preferred
  • Call center experience preferred
  • Understanding of denials processes for Medicare, Medicaid, and Commercial/Managed Care product lines, a plus
  • Prior experience of accessing hospital EMR’s and Payer Portals preferred
  • Proficient in MS Word and Excel
  • Accurate keyboard skills

Physical Requirements:

May be expected to sit at a desk for long hours. Repetitive movement of hands and fingers – typing and/or writing. Occasional standing, walking, stooping, kneeling, or crouching. Ability to reach with hands and arms, talk, and hear. Exert up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects

Versalus Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics, or any other basis forbidden under federal, state, or local law.

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