Medical Appeals Specialist

Job Summary

Working remotely in a full-time capacity, the Medical Appeals Specialist will manage the reconciliation of appeals from the Provider/MAC and serve as a key contact between the MAC and internal departments, ensuring compliance with regulations and company standards.

Key responsibilities

• Accurately receive, review, and forward appeal documents while ensuring compliance with federal and state regulations
• Process appeal documents efficiently and upload media to accounts, ensuring successful uploads
• Provide recommendations for workflow and process improvements to enhance efficiency and accuracy

Required qualifications

• High School diploma or GED required
• 5+ years of experience in relevant office or administrative roles, preferably in healthcare
• Demonstrated knowledge of healthcare audit and appeals processes, with Medicare and Medicaid experience preferred
• Intermediate skills in MS Excel and MS Word
• Strong knowledge of medical documentation and ability to meet strict deadlines