Appeals Specialist

Job Summary

Reviewing denied claims and submitting well-documented appeals, the full-time remote Appeals Specialist will maximize reimbursement for specialized laboratory services while collaborating with internal teams to enhance appeal success rates.

Key responsibilities

• Review and analyze denied claims to assess appeal potential and determine the basis for denial
• Communicate with healthcare providers and insurance representatives to gather necessary documentation for appeals
• Monitor and follow up on submitted appeals to ensure timely resolution and compliance with healthcare regulations

Required qualifications

• 3-5 years of experience in laboratory billing appeals
• Strong understanding of insurance policies, healthcare regulations, and medical terminology
• Expertise in appeals process for major insurance plans, Medicaid, and Managed Medicaid
• Knowledge of industry regulations, including HIPAA
• Proficiency in Microsoft Office Suite for reporting and documentation