Appeals Specialist I

Job Summary

A company is looking for an Appeals Specialist I to manage provider billing disputes and appeals.

Key Responsibilities

• Conduct analysis and decision-making for provider billing disputes and appeals
• Coordinate with clinical reviewers and document appeal recommendations and outcomes
• Provide education and assistance to members and providers regarding the appeal process

Required Qualifications

• High school diploma or GED with a minimum of 4 years of experience in customer service, claims, or clinical services
• Coding certification preferred for Specialist I
• Knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCs)
• Experience with claims processing and clinical services operations
• Ability to manage a defined caseload while adhering to productivity and quality expectations