Appeals Specialist Job at Robert Half (Mountlake Terrace)

Appeals Specialist

We are looking for an experienced Appeals Specialist to join our team on a contr...

Location

United States , Lynnwood

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience in claims processing or healthcare patient services/customer service is preferred
Familiarity with healthcare industry platforms
Strong proficiency in data entry
Demonstrated ability to work effectively in a Windows-based PC environment
Excellent multitasking and organizational skills to manage workloads efficiently
Strong attention to detail with a focus on meeting productivity and quality benchmarks

Job Responsibility

Review and analyze incoming mail and faxes to route them to the appropriate recipient
Conduct thorough research using reference materials, online tools, and proprietary systems
Enter and manage new cases in the system, ensuring all production goals are consistently met
Accurately identify and prioritize expedited appeal requests for timely processing
Respond to appeals that require claimant authorization, adhering to all privacy guidelines
Validate and handle privacy-related tasks, including processing authorizations and managing confidential documents
Assist with office supply orders and scheduling appeal panels as needed
Help the department meet quality and productivity standards through teamwork and individual contributions
Perform additional tasks as assigned to support overall team goals

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Appeals and Grievance Specialist II - HP Appeals Grievances

This position requires the ability to work independently researching and reviewi...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Associate Degree Preferred
Previous Appeals and Grievance experience with Managed Care Plans
Good typing and letter writing skills
Excellent written and oral communication skills
Excellent research and analytical skills
Basic computer knowledge
Excellent customer service skills
Ability to work well with diverse groups of individuals
Utilizes effective communication and conflict management skills

Job Responsibility

Research and provide resolution to issues such as claim denials, member and provider complaints, and reconsideration and redetermination requests
Review and respond to complaints, grievances and appeals within the stated time frame for each request
Ensure 95% compliance with the Center for Medicare and Medicaid Services (CMS) guidelines is met by adhering to all state and federal regulations
Analyze and resolve customer inquiries by adhering to CMS guidelines and CHRISTUS Health internal policies and procedures
Actively communicate with other associates to guarantee accurate and timely responses to inquiries involving internal/external customer needs
Be proactive in educating members, providers and others about CHRISTUS Health plans appeal/grievance process, plan terminations, contract terminations and benefit summary
Certify that providers and members are reimbursed accordingly using Medicare reimbursement policies and procedures

Fulltime

Acute Coding Appeals Specialist

The Acute Coding Appeals Specialist reviews and writes appeals for inpatient DRG...

Location

United States , Minneapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

5+ years of inpatient facility coding experience (required)
Experience handling appeals, denials, and claim edits
Advanced knowledge of coding systems, billing processes, and regulatory standards
Strong research, analytical, and written communication skills
Ability to track trends and identify root cause issues
High School Diploma or GED (minimum)
Active coding certification required (RHIA, RHIT, CCS, CIC, CPC, COC, etc.)

Job Responsibility

Review inpatient DRG denials and draft well-supported appeal letters using ICD-10-CM/PCS, HCPCS, NCCI, CMS, and CMG guidelines
Analyze clinical documentation to validate the originally assigned DRG and ensure compliance with regulatory standards
Research payer policies, government regulations, and industry guidelines to strengthen appeal arguments
Maintain detailed documentation, tracking spreadsheets, and root cause analyses for denial trends
Collaborate with client coding and CDI teams to provide education based on appeal outcomes
Meet established productivity and quality standards while maintaining coding certification requirements
Stay current on coding updates, regulatory changes, and reimbursement rules
Deliver professional, organized, and customer-focused communication with clients

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Remote Coding Appeals Specialist

Join our team as a Remote Coding Appeals Specialist and play an essential role i...

Location

United States , Indianapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Demonstrated proficiency in ICD-10-CM, ICD-10-PCS, HCPCS, NCCI, CMS, and CMG coding systems
Experience with medical coding appeals and denials
Strong understanding of healthcare regulatory standards and quality assurance principles
Effective written and verbal communication skills
5 years of direct heads down production coding
Ability to work independently in a remote environment

Job Responsibility

Apply medical coding principles and industry guidelines objectively during appeals and denial review processes
Leverage knowledge of ICD-10-CM, ICD-10-PCS, HCPCS, NCCI, CMS, and CMG to identify, analyze, and resolve billing and coding issues
Assess quality concerns by verifying adherence to regulatory requirements and best practices
Participate in client system education to gain familiarity with specific platforms and workflows
Ensure all appeals are accurately supported by clinical documentation, coding/CDI guidelines, and regulatory standards
Collaborate with clients and internal stakeholders to clarify documentation and coding requirements

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

Claims & Appeals Specialist

This is a full-time hybird position based in St. Paul, with three on-site days p...

Location

United States , Saint Paul

Salary:

51200.00 - 76800.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

High school diploma or equivalent experience required
1+ years of medical collections and/or billing

Job Responsibility

Perform collections activities on all outstanding claims for assigned payers
Enter and work all denials received from assigned payers within specified timeframe
Demonstrate a basic understanding of compliance policies for Baxter, including commercial and government payers
Create, submit, and follow through on appeals for assigned payers
Research and reconcile credit balances on accounts
Process corrected claims and/or rebills to assigned payers as needed and adjustments following the established policy and procedures
Document and follow up on explanations of benefits (EOBs)
Identify and articulate trending payer issues and notify appropriate leaders in a timely manner
Provide quality customer service, with the ability to speak knowledgably to payers, patients, and other collaborator and be able to verify benefits and understand coverage criteria

What we offer

Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP)
401(k) Retirement Savings Plan (RSP)
Flexible Spending Accounts
Educational assistance programs
Paid holidays
Paid time off ranging from 20 to 35 days based on length of service
Family and medical leaves of absence
Paid parental leave

Fulltime

Appeals Specialist I

Responsible for all activities associated with requests for Provider Billing Dis...

Location

United States , Portland

Salary:

25.00 - 30.00 USD / Hour

Apex Systems

Expiration Date

Until further notice

Requirements

Excellent verbal and written communication skills
Intermediate computer skills (e.g. Microsoft Word, Excel, Outlook)
Knowledge of medical terminology, anatomy and coding (CPT, DX, HCPCs)
Knowledge of claims processing and clinical services operations
Demonstrated initiative and analytical ability in identifying problems, researching issues, developing solutions, and implementing a course of action
Ability to listen and communicate appropriately in a manner that promotes positive, professional interaction while maintaining confidentiality and sensitivity in all aspects of internal and external contacts
Ability to present complex medical and reimbursement information to others and to be diplomatic and persuasive regarding health plan benefits, claims and eligibility
Ability to switch from one task or type of work to another as the business needs require
Ability to effectively prioritize work to meet strict timelines while maintaining quality and consumer centric focus
High school diploma or GED and a minimum 4 years’ experience in customer Service, Claims, or Clinical Services or equivalent combination of education and work experience

Job Responsibility

Responsible for all activities associated with appeal analysis, decision-making and closure
Appeal Intake – Validate intake determinations regarding timeliness, member benefits, employer group, and provider contract provisions for each appeal. Document information in appropriate system
Appeal Analysis – Review claim coding and claim processing history, medical policy and reimbursement policies, regulatory and legal requirements, benefit contracts, and/or provider contracts. Collect and catalogue supporting documentation and formulate an appeal recommendation. Document information in appropriate system. Apply knowledge and experience to answer a variety of increasingly complex inquiries from members, providers, and provider representatives. Collaborate effectively with coding specialists, appeal nurses, physician reviewers, and others as necessary to reach timely decisions on appeals
Decision & Closure – Make non-clinical appeal determinations as permitted by department business processes and guidelines. Follow department’s processes to receive a clinical review and decision from licensed health professionals. Present complex cases to appeal panels, document decisions, communicate determinations to members, providers or their representatives. Document information in appropriate system(s)
External review process – Oversee set-up of appeals for external review organizations, including document collection and coordination, communication with all parties, and other responsibilities as an intermediary between the provider and the external review organization. Ensure external review information is documented in appropriate system. Prepares letters and cases for external review as needed. Implement external review decisions
Interpersonal and Communication – Provide information, education and assistance to members, providers, and their representatives. Facilitate the member’s or provider’s’ understanding of the appeal process and of the information necessary to effectively process an appeal. Be a courteous advocate to the member or provider when requesting supporting information. Work cooperatively and effectively across all business areas to resolve
Systems and data – Track appeals in appropriate systems and assist in the maintenance of files. Assist with compilation of reports on appeals, including trends, number of cases, decisions, suggestions for process improvement, types of appeals, and compliance with timelines
Support, apply and promote Provider or Member Appeal Policies & Procedures
Adhere to dependability, customer focus, and all performance criteria as established by the department including: timeliness, production, and quality standards for all work
Manage a defined caseload within department productivity and quality expectations and provide back up for other appeals staff

What we offer

Medical, dental, vision, life, disability, and other insurance plans
ESPP (employee stock purchase program)
401K program with company match after 12 months
HSA (Health Savings Account on the HDHP plan)
SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions
Corporate discount savings program
On-demand training program
Access to certification prep and a library of technical and leadership courses/books/seminars after 6+ months of tenure
Certification discounts and other perks to associations that include CompTIA and IIBA
Dedicated customer service team for Consultants

Fulltime

Appeals and Grievance Specialist II

This position requires the ability to work independently researching and reviewi...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Associate Degree Preferred
Previous Appeals and Grievance experience with Managed Care Plans
Good typing and letter writing skills
Excellent written and oral communication skills
Excellent research and analytical skills
Basic computer knowledge
Excellent customer service skills
Ability to work well with diverse groups of individuals
Utilizes effective communication and conflict management skills

Job Responsibility

Research and provide resolution to issues such as claim denials, member and provider complaints, and reconsideration and redetermination requests
Review and respond to complaints, grievances and appeals within the stated time frame for each request
Ensure 95% compliance with the Center for Medicare and Medicaid Services (CMS) guidelines is met by adhering to all state and federal regulations
Analyze and resolve customer inquiries by adhering to CMS guidelines and CHRISTUS Health internal policies and procedures
Actively communicate with other associates to guarantee accurate and timely responses to inquiries involving internal/external customer needs
Be proactive in educating members, providers and others about CHRISTUS Health plans appeal/grievance process, plan terminations, contract terminations and benefit summary
Certify that providers and members are reimbursed accordingly using Medicare reimbursement policies and procedures

Fulltime

Rcm reimbursement specialist focused on appeals and denials

We are seeking an experienced and detail‑oriented RCM Reimbursement Specialist f...

Location

United States , Houston

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

College degree preferred, or equivalent experience (5+ years)
Minimum 5 years of medical billing experience, with strong preference for candidates experienced in molecular laboratory billing
Understanding of HIPAA regulations and proper handling of PHI
Solid working knowledge of health insurance plans, reimbursement policies, and claims terminology
Strong communication and interpersonal skills
Highly meticulous with strong analytical and problem‑solving abilities
Strong knowledge of insurance guidelines, CPT/ICD‑10 coding, and medical terminology
Excellent attention to detail and time management
Effective communication and problem‑solving abilities
Proficiency in Microsoft Office Suite and healthcare billing software tools

Job Responsibility

Resolve aged claims and appeals lacking payer responses through payer portals and outbound calls
Identify claims requiring first, second, or third‑level appeals
Support teammates with special projects and denial work queue management
Prioritize an assigned work queue to ensure timely follow‑up while maximizing reimbursement opportunity
Identify non‑payment trends and partner with Revenue Cycle leadership to escalate groups of claims to Market Access
Investigate denial and non‑payment trends identified by Revenue Cycle Analytics and collaborate cross‑functionally to propose and implement solutions
Communicate opportunities to improve upstream processes that may prevent future denials
Engage patients when their involvement is required during the appeal process
Collaborate professionally with Revenue Cycle team members and respond promptly to requests requiring assistance

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

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Appeals and Grievance Specialist II

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