Reimbursement Specialist - Appeals

Job Summary

To support post-submission reimbursement activities, the full-time remote Reimbursement Specialist - Appeals will manage claims denials, prepare and submit appeals, and communicate with payers to ensure accurate reimbursement across various insurance plans.

Key responsibilities

• Manage and investigate various denial types, preparing appeals for submission and follow-up
• Review Explanation of Benefits (EOBs) to identify root causes of denials and determine next steps
• Maintain accurate documentation of denials and appeals actions while ensuring compliance with billing regulations

Required qualifications

• 4+ years of experience in reimbursement, denials management, or revenue cycle management
• Bachelor's degree or equivalent experience
• Experience with Xifin, Quadax, or Telcor preferred
• Strong understanding of medical benefit structures and coding guidelines
• Proven ability to analyze denials and resolve issues effectively