Appeals Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Examine and evaluate denied claims to identify the reasons for denial and assess the potential for appeal.

• Engage with healthcare providers and insurance representatives to collect necessary documentation for the appeals process.

• Ensure that all required documentation from payors is submitted with each appeal and recorded in the billing system.

• Monitor and follow up on submitted appeals to guarantee prompt resolution.

• Implement healthcare regulations, payor policies, and coding standards to ensure compliance throughout the appeals process.

• Identify and evaluate denial patterns, suggesting process enhancements to minimize future denials.

• Investigate payor-specific appeal procedures to confirm that appropriate steps are taken.

• Collaborate with clinical teams, market access, and insurance representatives to address issues related to appeals.

⛳️ Requirements

• 3-5 years of experience in laboratory billing appeals.

• Comprehensive understanding of insurance policies, healthcare regulations, medical terminology, and coding.

• Proficiency in the appeals process for major insurance plans, Medicaid, and Managed Medicaid.

• Capability to manage multiple tasks and prioritize effectively.

• Familiarity with industry regulations, including HIPAA.

• Experience with Xifin is advantageous.

• Exceptional attention to detail and strong organizational skills.

• Proficient in Microsoft Office Suite (Excel, Word, Outlook, and Teams) for reporting and documentation purposes.

• Availability to support EST hours.

🏝️ Benefits

• Paid Time Off (PTO)

• Health, Dental, Vision, and Life insurance

• 401k Retirement Savings Plan

• Employee Stock Purchase Plan

• Employee Discounts

• Voluntary benefits

• Programs for parents and parents-to-be