HCFS, Inc.

  • Authorization/Appeals Specialist

    Job Locations US-TX-Frisco
    Job ID
    Authorization/Appeals Coordination
    Regular Full-Time
  • Overview


    HCFS, Inc. is a Revenue Cycle Solution and Third-Party Eligibility Company hired by hospitals and hospital systems to maximize their business office processes and minimize the amount of bad debt incurred from self-pay patients.Our clients hire HCFS to be Subject Matter Experts to simplify and handle the preparation of authorizations, treatment authorization requests and appeals to maximize the number of billing days allowed by the payer.


    You, as our Authorization and Appeals Specialist, will:

    • Review medical records and prepare authorizations as appropriate.
    • Review denials and medical records and prepare appeals as appropriate.
    • Follow up on all pending authorizations and appeals until resolution.
    • Analyze medical documentation and apply criteria to determine medical necessity, acuity of care, severity of illness and intensity of service.
    • Check third-party payer eligibility to ensure that the information provided matches the database information.
    • Communicate authorization and appeal status to assigned facilities and onsite HCFS staff.
    • Submit and/or mail the retro-authorization form and supporting documentation to payer program.
    • Update accounts based on balance and update systems as work is completed.
    • Prepare daily, weekly and monthly reports for facilities and other departments.
    • Communicate issues and project status to management.
    • Follow suspense dates in internal system to update account status on the authorizations or appeals on a timely basis.
    • Handle and manage multiple tasks and duties; organize and prioritize workload in a timely manner.

    You will be part of a larger HCFS team focused on patient advocacy and hospital profitability! Establishing strong professional relationships with our hospital contacts and HCFS team is imperative. Your individual success, as well as the profitability of the hospital and HCFS relies on your efforts to Provide a Collaborative environment.


    We can make a difference in our communities with our solid business model.  We should Expect Excellence each and every day!


    THE “MUST HAVES” (aka the Minimum job requirements) 

    • Working knowledge of Medical Terminology
    • At least 1 year of experience with CPT, DRG and ICD-9/10 codes
    • At least 2 years of filing retrospective, concurrent or prior authorizations is required
    • Must have excellent follow through skills during the application process
    • Must demonstrate the ability to multi-task job responsibilities and remain focused on these duties for long periods of time
    • Must possess strong written and verbal skills
    • Consistent punctuality and attendance is required


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