< Back to Careers

Appeals Specialist

Title: Appeals Specialist

We are seeking a dynamic and experienced Appeals Specialist to join our team, playing a pivotal role in our accounts receivables department. The ideal candidate will conduct thorough reviews of medical records and draft compelling appeals to insurance companies based on ASAM, LOCUS, federal, and/or commercial insurance guidelines.

Qualifications

  • 2+ years experience in behavioral health/substance abuse industry
  • 2+ years of auditing or medical review experience, preferred
  • Highly organized and able to track workflows through various tools
  • Excellent communication skills, both written and spoken
  • Knowledge of health care evaluation methodology, medical terminology, and regulations
  • Strong organization and data management skills, including word processing, spreadsheets, monitoring and evaluation tools
  • Strong time management and critical thinking skills

Preferred Experience: Knowledge of any of the following EMR/Billing Softwares: Kipu, Best Notes, Alleva, NetSmart/MyAvatar, Medsphere, Sunwave, CollaborateMD

Job Type: Full-time

Pay: $22.00 – $28.00 per hour

Expected hours: 40 per week

Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Retirement plan
  • Vision insurance

Healthcare setting:

  • Clinic
  • Inpatient
  • Outpatient
  • Telehealth

Medical specialties:

  • Addiction Medicine

Schedule:

  • 8 hour shift
  • Day shift
  • Monday to Friday

Work Location: Remote

Responsibilities:

  • Responsible for conducting medial record reviews and responding to both clinical and administrative denials in a timely manner
  • Composes and submits all required documentation (including appropriate medical records to support medical necessity) for a reconsideration, appeal, or retro authorization to the insurance carrier via payer portal, fax or mail
  • Collaborates with other departments/resources/entities as applicable to ensure the most optimal appeal outcome.
  • In collaboration with multi-departmental subject matter experts, identify denial trends and patterns and creates education and guidance on root causes and any preventable measures that can be put in place
  • Utilizes appropriate applications to accurately track clinical denial data, participates in the development and implementation of a system-wide process for appeals to include tracking of success rates
  • Maintains strong working knowledge of any payer guidelines & appeals processes, including any state and regional requirements
  • Provides recommendations and education to CDI, Coding, and RCM leadership as a result of process and documentation improvement opportunities that are resulting in clinical denials.
  • Gathers and fill out any payer specific forms and letters
  • Apply clinical and industry guidelines, and use of in-depth knowledge that supports medically necessity of services rendered
  • Meet success rate metrics for appeal outcomes
  • Effectively manage and work to maintain timely responses to denials within specific deadlines

Apply for this position

Name(Required)
Max. file size: 100 MB.
Max. file size: 100 MB.
Are you currently employed?
Are you licensed/certified for the job?