Appeals Specialist

Job Overview
We are seeking a motivated and detail-oriented Appeals Specialist to join our dynamic team. In this role, you will be responsible for managing the appeals process related to insurance claims, ensuring accurate review and resolution of denied or disputed claims. Your expertise will help facilitate communication between healthcare providers, insurance companies, and patients, ultimately supporting the organization's mission to deliver exceptional service and ensure compliance with industry standards. This position offers an exciting opportunity to utilize your medical coding knowledge, organizational skills, and understanding of insurance regulations to make a meaningful impact.

Responsibilities

• Review and analyze medical documentation, including medical records, coding, and billing information to determine the validity of insurance claim denials or disputes.
• Manage the appeals process by preparing detailed appeal letters and supporting documentation in accordance with insurance policies and legal requirements.
• Verify insurance coverage and benefits for Medicare, Workers' Compensation law, HCPCS (Healthcare Common Procedure Coding System), ICD (International Classification of Diseases) coding (ICD-9 and ICD-10), CPT (Current Procedural Terminology) codes, DRG (Diagnosis-Related Group), and other relevant medical coding standards.
• Communicate effectively with healthcare providers, insurance representatives, and patients to gather necessary information and resolve issues promptly.
• Maintain accurate filing systems for medical records, insurance correspondence, and appeal documentation using financial software and medical record management tools.
• Ensure compliance with all applicable regulations related to medical billing, coding, and appeals procedures while adhering to organizational policies.
• Track appeal statuses diligently, follow up on outstanding cases, and generate reports to monitor workflow efficiency.
• Post Payments if needed

Qualifications

• Proven clerical experience with strong organizational skills in managing files, documentation, and correspondence.
• Knowledge of medical terminology, ICD-10 coding systems, CPT coding, HCPCS codes, and Medicare guidelines.
• Familiarity with workers' compensation law and medical billing processes.
• Experience verifying insurance benefits and performing insurance verification tasks accurately.
• Proficiency in using financial software applications as well as electronic health record systems for maintaining detailed records.
• Excellent communication skills for liaising with healthcare providers, insurers, and patients effectively. Join us as an Appeals Specialist to play a vital role in ensuring claims are processed efficiently while maintaining compliance with industry standards Your dedication will support our commitment to delivering outstanding service through meticulous review processes combined with expert knowledge of medical billing and coding practices.

Job Type: Full-time

Pay: From $18.00 per hour

Expected hours: 40 per week

Benefits:

• Paid time off

Work Location: Remote