Insurance Follow-Up & Appeal Specialist

FT, 80 hrs/pp, 1.0 FTE; (3 positions), varies as scheduled

Job Summary:

The Insurance Follow-Up & Appeals Specialist is responsible for the timely and accurate resolution of unpaid, underpaid, and denied insurance claims. This role focuses on proactive payer follow-up, denial analysis, and appeal submission to ensure appropriate reimbursement in compliance with payer contracts, Medicare/Medicaid regulations, and organizational policies. The specialist serves as a subject-matter resource for complex payer issues and supports revenue integrity through detailed documentation, trend analysis, and collaboration with internal teams.

Required:

High School Graduate or GED. Minimum 1 year of insurance follow-up, denial management, or appeals experience in a healthcare revenue cycle setting. Working knowledge of medical billing, insurance benefits, and EOB interpretation. Experience with Medicare, Medicaid, and commercial payers preferred. Strong analytical, organizational, and problem-solving skills. Ability to communicate professionally and effectively, both verbally and in writing.

Preferred:

Experience in a Critical Access Hospital (CAH) or rural health setting. Familiarity with Epic or similar hospital billing systems. Knowledge of CPT, HCPCS, ICD-10, and basic payer contract concepts. Prior experience preparing medical necessity or technical appeals.

Compensation & Benefits Pay Range:

$22.25-$32.25 Excellent health, dental, and vision benefits Retirement plan with employer contributions Generous paid time off Why Prosser? Prosser Memorial Health is proud to be the ONLY Critical Access Hospital in Washington State with a 5-Star CMS rating and ranked among the Top 10 Recommended Hospitals in Washington .

Community Highlights:

Friendly, welcoming community at the heart of Washington wine country 300 days of sunshine with easy access to the Yakima River and outdoor recreation Just 30 minutes from the Tri-Cities (Pasco, Kennewick, Richland) and the Tri-Cities Airport (PSC) Cost of living 18% lower than the national average Quick 30-minute flights to Seattle, WA, or Portland, OR National recognition: #1 Best Suburbs to Buy a House in WA (Niche) #1 Best Places to Live in WA (AreaVibes) #1 Most Secure Mid-Sized City in the U.S. Join Our Team! At Prosser Memorial Health, you'll find more than just a job—you'll find a community and a mission. Whether you're an experienced professional or a new graduate, this is an opportunity to grow your career in a supportive environment, with state-of-the-art facilities and an outstanding team.