Appeals Specialist

Job Description

We are seeking a detail-oriented and experienced Appeals Specialist for our client in Middleburg Heights, Ohio. In this role, you will be responsible for managing insurance claim denials and leading the appeals process to secure appropriate reimbursement. The ideal candidate is highly organized, knowledgeable in medical billing and payer requirements, and skilled in analyzing claims and preparing effective appeals.

Position Details:

• Direct Hire Opportunity
• Pay: $19.50-$21.00
• Monday-Friday 8am-5pm
• 3 months in office then remote
• Benefits offered

Key Responsibilities

• Review assigned insurance denials and EOBs to identify appeal opportunities and determine required documentation.
• Analyze case history, payer guidelines, and state regulations to develop effective appeal strategies.
• Obtain necessary patient and/or physician authorizations and medical records in accordance with insurance and regulatory requirements.
• Complete and submit all required appeal forms, ensuring accuracy and completeness.
• Draft professional appeal letters, compile supporting documentation, and submit appeals in a timely manner.
• Coordinate and schedule phone hearings with insurance representatives, patients, and providers as needed.
• Adhere to all established procedures for appeals, including proper documentation and compliance standards.
• Manage assigned worklists to ensure all appeal deadlines are met; escalate issues to management when assistance is needed.
• Monitor and report changes in payer requirements, state regulations, or denial trends to leadership.
• Participate in team meetings by providing updates and insights on cases and outcomes.
• Provide backup support for incoming calls when necessary.
• Assist with special projects and additional tasks as assigned by leadership.

Qualifications

• High school diploma or GED required.
• Previous experience in healthcare billing, specifically in insurance claims and appeals.
• Strong knowledge of the managed care industry, including payer structures, administrative processes, and government payers (e.g., Medicare/Medicaid).
• Proficient in reimbursement processes and denial resolution.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities and work independently in a fast-paced environment.
• Strong attention to detail and analytical skills.
• Ability to maintain strict confidentiality in accordance with HIPAA and company policies.

If you feel you meet the above qualifications, please apply for immediate consideration.

All qualified applicants will receive consideration for employment without regard to race, color, religion, ethnicity, national origin, sex, gender identity, sexual orientation, disability status, protected veteran status or any other protected status under the law. EverStaff is an equal opportunity employer (M/F/D/V/SO/GI).