Appeal Support Specialist

Appeal Support Specialist

We are a professional staffing firm, working with organizations across the country to place exceptional candidates. Currently, we have an Appeal Support Specialist opportunity with a nationally recognized healthcare system that combines cutting-edge medical innovation with compassionate, patient-centred care, offering rewarding career growth in a supportive environment.

The Appeal Support Specialist is responsible for the specific duties listed below. Your specific duties will include:

• Process reconsiderations, redeterminations, appeals, resubmissions of previously submitted appeals, State Complaint letters, and legal submissions to the Administrative Law Judge.
• Submit requests for Coordination of Benefits or Patient Consent letters to patients.
• Ensure all submitted documentation is accurate, complete, and includes required forms.
• Submit documentation through appropriate provider portals, payer addresses, or fax numbers.
• Ensure submissions are delivered prior to payer-established deadlines.
• Draft appeal letters outlining denial details and supporting justification for overturning claims.
• Pull medical records and supporting documentation from prior hospitalizations, care episodes, or physician office records.
• Compile documentation for accounts escalated to the Managed Care Legal team following Insurance Operations review.

Required qualifications for the position include:

• High School Diploma or GED equivalent.
• Minimum of 2 years of relevant experience.
• Strong written and verbal communication skills.
• Advanced computer skills including typing, electronic medical documentation, scanning, email.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).

Preferred qualifications for the position include:

• Experience handling payer correspondence and documentation workflows.

Pay Rate: $22.00 per hour Compensation may vary outside of this range depending on a number of factors, including a candidate's qualifications, skills, competencies and experience, and location. Employees have access to healthcare benefits including medical, dental and vision as well as a 401(k) plan. Let one of our recruiters assist you in finding and preparing for interviews with our clients. Whether you are interested in a direct hire, temp-to-hire, or temporary position, Workway can help you to put your best foot forward. Workway, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by applicable laws, regulations and ordinances.