Appeals Resolution Specialist

Job Summary

Managing complex payer deferrals, denials, and appeals, the full-time remote Appeals Resolution Specialist will support timely resolution and successful authorization outcomes while serving as a subject matter expert in researching payer decisions and preparing comprehensive appeal submissions.

Key responsibilities

• Review and manage assigned deferrals, denials, and appeals to ensure timely resolution
• Analyze payer correspondence and medical documentation to identify underlying causes of payer decisions
• Prepare clear and persuasive appeal submissions, coordinating with internal departments as needed

Required qualifications

• High School Diploma or G.E.D. required
• Strong knowledge of healthcare payer requirements, authorization processes, and appeals
• Ability to interpret payer policies and medical documentation
• Excellent written communication skills for developing appeal documentation
• Proficiency with applicable payer portals and Microsoft Office applications