Appeals Coordinator

Appeals Coordinator (Healthcare Revenue Cycle)

This role plays a critical part in maximizing reimbursement and protecting revenue through expert-level appeals and payer negotiations.

What You'll Do

• Maximize reimbursement by identifying, documenting, and resolving contracted and non-contracted underpayments
• Draft and submit high-quality appeal letters supported by clinical documentation and regulatory standards
• Manage and resolve complex claim denials, including: Medical necessity, Usual & customary reductions, Not-to-closest-facility rulings, Ground-level payment reductions
• Build and maintain strong working relationships with commercial, Medicare, Managed Care, and Workers' Comp payers
• Research statutes, payer policies, and regulatory guidelines to support appeals
• Partner with Patient Financial Services leadership to improve workflows and outcomes
• Identify trends and recommend process improvements across revenue cycle operations
• Represent the organization with a professional, compliant, and customer-focused approach

Required Qualifications

• High School Diploma or GED (Bachelor's degree preferred)
• 5+ years of medical billing experience (EMS, emergency, or surgical billing strongly preferred)
• 3+ years of direct appeals writing and payer negotiation experience
• Experience with commercial and non-contracted commercial payers
• Strong knowledge of Medicare, Managed Care, and Workers' Compensation
• Proven ability to interpret compliance, regulatory, and payer requirements
• Demonstrated success drafting professional, persuasive appeal letters
• Solid understanding of: Patient account systems, Revenue management processes, Workflow systems and optimization
• Advanced written and verbal communication skills
• Ability to work independently while collaborating effectively with cross-functional teams

Pay Details: $53,000.00 to $65,000.00 per year

Search managed by: Joanna Calderon Equal Opportunity Employer/Veterans/Disabled Military connected talent encouraged to apply

The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance

Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.