Appeals Specialist Job at Robert Half (Lynnwood)

Appeals Specialist

We are seeking detail-oriented and customer-focused Appeals Specialists to join ...

Location

United States , Mountlake Terrace

Salary:

21.50 USD / Hour

Robert Half

Expiration Date

Until further notice

Requirements

High School Diploma or GED
Minimum six months of experience in customer service, administrative support, healthcare operations, claims processing, or a related field
Strong data entry and computer skills
Experience working with multiple systems and databases simultaneously
Ability to research information, analyze findings, and make appropriate decisions
Excellent attention to detail and organizational skills
Strong written and verbal communication abilities
Ability to work independently in a remote environment

Job Responsibility

Review and research incoming correspondence, documentation, and requests to determine appropriate routing and handling
Enter and maintain appeal cases and related information within internal systems
Research and validate information using various databases, reference materials, and online resources
Manage daily workload to meet established productivity, quality, and turnaround time expectations
Accurately identify and triage expedited appeal requests
Respond to internal inquiries via phone, email, and instant messaging as needed
Process authorization-related requests and ensure appropriate documentation is obtained
Assist with privacy-related activities and documentation requirements
Support administrative functions including filing, scanning, printing, and document management
Assist with scheduling activities and other operational support tasks as needed

What we offer

Equipment provided
No overtime anticipated
Opportunity to gain valuable experience within a large healthcare organization
Collaborative and supportive team environment
Medical, vision, dental, and life and disability insurance
401(k) plan

Fulltime

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 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

Appeals and Grievances Nurse Specialist RN II

The Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provi...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of experience in Clinical RN
At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment
Excellent interpersonal and communication skills
Computer literacy and adaptability to computer learning
Time management and priority setting skills
Must be organized and a team player
Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies
Good working knowledge of regulatory requirements/standards
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Conducts intake/triage and appropriate classification of Clinical A&G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the department
Investigation, and resolution of clinical member complaints (grievances/appeals) utilizing all regulatory requirements
Investigation, and resolution of clinical Provider Complaints/ Provider Data Resolution (PDR) (grievances/appeals) utilizing regulatory and internal guidelines and Service Level Agreement (SLA)
Identification of Expedited Cases and resolution within 72 hours
Works with the external providers and Participating Physician Group's (PPG) representatives to obtain relevant medical records and communication documentation
Prepares resolved complaint files for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE)
Process the case thru to effectuation and final case documentation in the A&G system of record
Investigation and preparation of State Fair Hearing cases as assigned
Prepares resolved complaint files for CMS external review organization - Quality Improvement Organization (QIO) or Independent Review Entity (IRE)
Conducts reviews and presents to physicians, provider disputes which would be based on medical necessity reviews

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

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Appeals Specialist

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