Appeals Specialist

Job Summary

A company is looking for an Appeals Specialist I.

Key Responsibilities

• Manage requests for Provider Billing Disputes and Appeals, including analysis and evaluation of prior determinations
• Coordinate clinical reviews when necessary and ensure compliance with relevant guidelines and regulations
• Provide assistance and information to members, providers, and other stakeholders regarding benefits and claims

Required Qualifications

• Experience in handling appeals or billing disputes in a healthcare setting
• Knowledge of healthcare regulations and compliance requirements
• Ability to work remotely and manage tasks independently
• Familiarity with insurance processes and claims management
• High school diploma or equivalent; further education in healthcare or related field preferred