Appeals Specialist I

Job Summary

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

Key Responsibilities

• Validate intake determinations and document information in the appropriate system
• Review claim coding, processing history, and formulate appeal recommendations
• Provide information and assistance regarding the appeal process to members and providers

Required Qualifications

• High school diploma or GED required
• Minimum 4 years' experience in Customer Service, Claims, or Clinical Services
• Coding Certification (CPC, CCS, or similar) preferred
• Experience with AI tools and technologies is highly desired