Senior Appeals Specialist

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

📋 Description

• Engage in all appeal worklists as necessary, with a possible emphasis on contracted or sensitive insurance providers.

• Relay denial and appeal patterns to the client engagement and payer relations teams.

• Act as a Subject Matter Expert (SME) in insurance appeals and collaborate with management to provide updates to clients.

• Acquire patient consent and medical records for appeals as mandated by the insurance plan.

• Collect updated appeal or review forms for inclusion in the form library.

• Draft appeal letters, compile the necessary materials according to client SOP, and submit via portal, fax, or mail.

• Adhere to all appeal process documentation and SOPs.

• Participate in team meetings, contributing case details.

• Share best practices with fellow team members.

• Mentor new or less experienced members of the appeals team.

• Execute special projects assigned by Production Management or clients.

• Analyze denials and EOBs for relevant appeal filing details, addressing any missing information.

• Notify management of any inaccuracies or omissions in appeal default information.

• Complete special appeal or review forms as needed.

• Initiate and manage payer projects, including the creation and upkeep of tracking spreadsheets.

• Flexibility to work on additional work lists as required.

• Collaborate directly with global teams to illustrate processes.

• After assuming the role, strive to obtain Lean Six Sigma (LSS) Yellow Belt or higher certification.

• Achieve or surpass productivity and quality KPI targets.

• Carry out other assigned duties.

⛳️ Requirements

• High School diploma or GED required.

• At least four years of health insurance billing experience or an equivalent degree.

• A minimum of one year of Quadax production experience is necessary.

• Proficient in PAS and HARP systems.

• Strong written and verbal communication skills are essential.

• Familiarity with the managed care industry, including payer structures, administrative regulations, and government payers.

• Competent in all aspects of reimbursement processes.

• Capable of working independently and prioritizing tasks effectively.

• Ability to maintain confidentiality at all times.

• Exceptional attention to detail is required.

• Must possess excellent written and verbal communication abilities.

• Able to set priorities, work autonomously, and pursue objectives without supervision.

• Strong computer skills, particularly in Microsoft Excel and Word.

🏝️ Benefits

• Equal Opportunity Employer.

• Opportunities for professional development.