Appeals Specialist

Job Overview We are seeking a dedicated and detail-oriented Appeals Specialist to join our dynamic healthcare team. In this role, you will be responsible for managing the appeals process related to denied or contested medical claims, ensuring timely and accurate resolution. Your expertise will help improve reimbursement outcomes by thoroughly reviewing medical documentation, understanding insurance policies, and applying relevant coding and legal knowledge. This position offers an exciting opportunity to contribute to patient care support and financial accuracy within a fast-paced healthcare environment. Responsibilities Review and analyze denied claims, identifying reasons for denial based on insurance policies, medical documentation, and coding errors. Prepare comprehensive appeal submissions by gathering supporting medical records, documentation, and relevant legal or regulatory information. Utilize medical terminology, ICD-9, ICD-10, CPT coding, HCPCS codes, and DRG classifications to accurately interpret medical records and justify appeals. Verify insurance coverage and benefits through insurance verification processes to support appeal cases. Maintain organized filing systems for all appeals documentation, ensuring compliance with confidentiality standards and regulatory requirements. Communicate effectively with insurance companies, healthcare providers, and patients to resolve discrepancies or request additional information. Keep detailed records of all appeal activities, including correspondence, outcomes, and follow-up actions using appropriate financial software or healthcare management systems. Qualifications Prior clerical experience in a healthcare setting or medical office environment is highly preferred. Strong organizational skills with the ability to manage multiple cases simultaneously while maintaining attention to detail. Knowledge of medical billing procedures, medical coding (ICD-9, ICD-10, CPT), HCPCS codes, DRG classifications, and workers' compensation law. Familiarity with medical documentation standards and medical terminology essential for accurate claim review. Experience with insurance verification processes and familiarity with Medicare regulations. Proficiency in using financial software or electronic health record systems for documentation and record keeping. Excellent communication skills to liaise effectively with insurance carriers, providers, and patients regarding claim status updates or additional information requests. Join our team as an Appeals Specialist if you are passionate about ensuring accuracy in healthcare billing processes while making a meaningful impact on patient care support!

Pay:

$16.00 - $18.00 per hour

Benefits:

Dental insurance Health insurance Vision insurance

Work Location:

In person