Appeals Representative

Job description Job Overwiew We are seeking a reliable and detail-focused Appeals Representative to support our healthcare claims and reimbursement operations. This position is responsible for reviewing denied or disputed insurance claims, preparing appeals documentation, and ensuring compliance with medical billing and insurance guidelines. The ideal candidate is organized, analytical, and capable of managing multiple cases while maintaining accuracy and professionalism. This role offers an opportunity to contribute to efficient claims resolution and support quality healthcare administrative services. Pay $24.00 - $32.00 per hour Key Responsibilities Examine denied or underpaid insurance claims to determine eligibility for appeal review. Review medical records, billing documentation, and insurance correspondence for accuracy and completeness. Prepare professional appeal packages, including written correspondence and supporting medical documentation. knowledge of ICD-9, ICD-10, CPT, HCPCS, and DRG classifications during claims evaluation. Research payer guidelines, Medicare policies, and workers' compensation regulations to support appeal submissions. Communicate with healthcare providers, insurance carriers, and internal departments regarding claim status and documentation needs. Maintain organized electronic records and accurately update case activity within company systems. Monitor appeal deadlines and ensure timely submission of all required materials. Assist with identifying recurring denial trends and support process improvement efforts. Protect confidential patient and financial information in accordance with company standards and applicable regulations. Support daily administrative operations related to claims management and appeals processing. Remain informed on updates to healthcare billing procedures, insurance policies, and coding standards. Requirements High school diploma or equivalent required. Previous experience in medical billing, healthcare administration, insurance claims, appeals processing, or administrative support preferred. Knowledge of medical terminology, insurance verification procedures, and healthcare documentation practices. Familiarity with

ICD-9, ICD-10, CPT, HCPCS

coding systems, and DRG classifications preferred. Understanding of Medicare guidelines and workers' compensation processes is an advantage. Strong organizational skills with excellent attention to detail and accuracy. Ability to prioritize tasks and manage multiple assignments effectively in a fast-paced environment. Proficiency with Microsoft Office, data entry systems, and case management or financial software platforms. Strong written and verbal communication skills. Ability to maintain professionalism and confidentiality while handling sensitive information. Dependable work ethic and ability to work independently as well as part of a team. Schedule Full-time Monday to Friday Day shift Benefits Health insurance Dental insurance Vision insurance Paid time off Retirement plan options Paid training Professional development opportunities Supportive team environment Join our team as an Appeals Representative and become part of a professional environment where your attention to detail, healthcare knowledge, and administrative skills will help support accurate claims resolution and quality patient service.

Job Types:

Full-time, Part-time Pay:

$24.00 - $32.00 per hour

Work Location:

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