Healthcare Appeals Representative

Job Summary

Working remotely in a full-time capacity, the Healthcare Appeals Representative will manage provider inquiries and appeals, ensuring compliance with client policies, CMS guidelines, and industry standards.

Key responsibilities

• Review, analyze, and complete appeals in accordance with client policy and CMS guidelines
• Interpret provider appeals and apply analytical thinking to resolve issues
• Utilize tools and resources to ensure timely completion of appeals and additional assigned duties

Required qualifications

• High school diploma or equivalent
• 3+ years of healthcare revenue cycle experience, including collections and appeals
• 2+ years of experience as an Appeals Representative
• Knowledge of medical terminology, coding, and contract interpretation
• Proficiency with Microsoft applications and ability to work across multiple software systems