Medical Claims Appeals Specialist

Job Summary

To enhance revenues for providers, the full-time Medical Claims Appeals Specialist will resolve insurance claim denials by generating effective written appeals and managing complicated denied claims in a remote work environment.

Key responsibilities

• Appeal denials through coding, contract, and medical record reviews, along with carrier interactions
• Analyze denial trends and patterns to proactively address recurring issues
• Serve as an escalation point for unresolved denial issues and assist in training new employees

Required qualifications

• 3-5 years of experience in medical practice billing with a focus on denials and appeals
• Bachelor's degree in a related field is strongly preferred
• ICD-10 and CPT coding assessment skills; CPC certification is preferred
• Intermediate PC software experience required
• Solid understanding of claims denial appeal logic and contract language application