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Top 17 Appeals Examiner Skills

Below we've compiled a list of the most important skills for an Appeals Examiner. We ranked the top skills based on the percentage of Appeals Examiner resumes they appeared on. For example, 17.2% of Appeals Examiner resumes contained Medical Policies as a skill. Let's find out what skills an Appeals Examiner actually needs in order to be successful in the workplace.

These are the most important skills for an Appeals Examiner:

1. Medical Policies

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high Demand
Here's how Medical Policies is used in Appeals Examiner jobs:
  • Educate Medicare providers/beneficiaries regarding the interpretation of claims guidelines, coverage and medical policies.

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2. Providers

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high Demand
Here's how Providers is used in Appeals Examiner jobs:
  • Reviewed medical information submitted by providers and beneficiaries in the appeal process to determine if the denied claim warranted payment.
  • Type clear and concise paragraphs with correct spelling and grammar to be sent to providers.
  • Prepared correspondence in freeform as needed from Beneficiaries or Providers.
  • Answered written redetermination requests by Providers or Beneficiaries.

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1 Providers Jobs

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3. Authority Hearings

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high Demand
Here's how Authority Hearings is used in Appeals Examiner jobs:
  • Preside over higher authority hearings on behalf of the Board on matters related to unemploymentinsurance appeals.

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4. CPT

demand arrow
high Demand
Here's how CPT is used in Appeals Examiner jobs:
  • Processed Medicare appeals Utilized and interpreted CPT and ICD-9 codes Computer skills
  • Processed Medicare appealsUtilized and interpreted CPT and ICD-9 codesComputer skills

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5. Unemployment Claims

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high Demand
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6. Icd-9

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average Demand

7. CMS

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average Demand

8. Medicare

demand arrow
average Demand
Here's how Medicare is used in Appeals Examiner jobs:
  • Trusted with complex Litigation preparation, this included presenting our client with accurate pricing guidelines and Medicare references.
  • Reviewed beneficiary and provider appeals on Medicare Part B claims that were previously denied for full or partial compensation.
  • Respond to incoming written appeals from Medicare providers and beneficiaries in a professional, timely and accurate manner.
  • Reprocessed Medicare claims for payments to providers.
  • Review and research Medicare Part B Chiroproactic claims in order to make payment decisions.

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9. Customer Service

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average Demand
Here's how Customer Service is used in Appeals Examiner jobs:
  • Worked with Customer Service, Authorization, Contracting and Eligibility Departments.
  • Exemplified superior and quality customer service; assisted providers with appeals via phone, mail, or peer to peer.

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10. Medical Records

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average Demand

11. Due Process

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low Demand

12. Fiss

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low Demand
Here's how Fiss is used in Appeals Examiner jobs:
  • Enter provider appeals into the computer using systems such as OnBase, FISS, MAS, and Database.

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14. Appeals Process

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low Demand
Here's how Appeals Process is used in Appeals Examiner jobs:
  • Assisted the medical department reconciling claims audited for overpayment and fraud at the second level of the appeals process.

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16. Production Standards

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low Demand
Here's how Production Standards is used in Appeals Examiner jobs:
  • Time management- meet deadlines, prioritize work, meet production standards with minimal errors.

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17. Relevant Evidence

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low Demand

Appeals Examiner Jobs

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17 Most Common Skills For An Appeals Examiner

Medical Policies

17.2%

Providers

14.1%

Authority Hearings

11.1%

CPT

6.1%

Unemployment Claims

6.1%

Icd-9

6.1%

CMS

5.1%

Medicare

5.1%

Customer Service

4.0%

Medical Records

4.0%

Due Process

3.0%

Fiss

3.0%

Legal Documents

3.0%

Appeals Process

3.0%

Legal Opinions

3.0%

Production Standards

3.0%

Relevant Evidence

3.0%
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Typical Skill-Sets Required For An Appeals Examiner

Rank Skill
1 Medical Policies 17.2%
2 Providers 14.1%
3 Authority Hearings 11.1%
4 CPT 6.1%
5 Unemployment Claims 6.1%
6 Icd-9 6.1%
7 CMS 5.1%
8 Medicare 5.1%
9 Customer Service 4.0%
10 Medical Records 4.0%
11 Due Process 3.0%
12 Fiss 3.0%
13 Legal Documents 3.0%
14 Appeals Process 3.0%
15 Legal Opinions 3.0%
16 Production Standards 3.0%
17 Relevant Evidence 3.0%
{[{skill.rank}]} {[{skill.name}]} {[{skill.percentageDisplay}]}%
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55 Appeals Examiner Jobs

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