Medical Appeals Specialist
New
J
JobgetherHealthcare
United StatesFull-TimeMiddle
Salary21 USD per hour
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Job Details
- Experience
- At least 5 years of relevant office, administrative, healthcare, or support experience
- Required Skills
- Microsoft Excel
Requirements
- High school diploma or GED required.
- At least 5 years of relevant office, administrative, healthcare, or support experience, ideally with progressively complex responsibilities.
- Demonstrated knowledge of healthcare audits, medical appeals, claims processing, billing, recovery processes, and related operational practices.
- Working knowledge of Medicare and Medicaid processes is strongly preferred.
- Strong understanding of medical documentation and the ability to accurately review and handle sensitive information.
- Intermediate proficiency with Microsoft Excel and Microsoft Word.
- Excellent multitasking and prioritization skills, with the ability to manage competing deadlines and changing requirements.
- Strong attention to detail and a demonstrated ability to maintain high-quality work while meeting strict production expectations.
- Ability to work independently, take ownership of assigned workloads, and complete tasks efficiently with appropriate judgment.
- Strong written and verbal business communication skills.
- Professional, courteous, dependable, conscientious, and reliable approach to work.
- Adaptability and willingness to adjust quickly to evolving business needs, processes, and priorities.
- Strong problem-solving skills and a collaborative mindset, with the ability to work effectively with different teams and stakeholders.
Responsibilities
- Receive, review, reconcile, and forward medical appeal documents and requests accurately and efficiently.
- Ensure all appeal activities comply with applicable federal and state regulations, contractual requirements, and established organizational guidelines.
- Process appeal documentation within required service levels while maintaining a consistently high standard of accuracy and quality.
- Upload media and supporting documentation to appropriate accounts, verify successful uploads, and resolve issues when necessary.
- Distribute designated media and appeal-related information to the appropriate internal departments.
- Serve as a key point of contact between providers, external stakeholders, and internal teams involved in the appeals process.
- Meet established daily and weekly production standards while maintaining accuracy and attention to detail.
- Identify workflow inefficiencies and recommend process improvements that can increase operational efficiency, accuracy, and consistency.
- Prioritize and manage multiple assignments effectively in a changing operational environment.
- Complete additional administrative, operational, and appeals-related responsibilities as assigned by department leadership.
- Collaborate with colleagues across locations and functions to resolve issues, address discrepancies, and develop practical solutions.
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