Appeals Specialist

1 month ago

Detroit, Michigan, United States R1 RCM Full time

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

As our Appeals Specialist, you will help the Appeals team investigate and examine denial accounts, so they can apply appropriate methods and techniques as established internally to resolve applicable issues. Everyday you will follow through with unresolved accounts, provide feedback to the appropriate staff on errors, and educate staff on all current trends in the appeals arena. Utilizes computer systems/programs, processes, policies and procedures as they apply and be able to trouble-shoot issues as they arise within the assigned specialization group. In addition, this position is required to learn how to conduct research analysis and work closely with third party payers to answer relevant questions and obtain appropriate information in pursuit of resolving unpaid claims. To thrive in this role, Appeals Specialist incumbents must be assessed as being resourceful and having extensive knowledge in area applicable to the assigned specialization group. Acts under direct supervision while learning to make complex decisions within the scope of this position.

Here's what you will experience working as an Appeals Specialist:

  • Investigates and examines source of denials utilizing knowledge of charge master, AS4, ICD-9 coding, CPT coding and EDI billing.
  • Reads and interprets expected reimbursement information from EOB's and learns legal parameters pertaining to all State and Federal Laws that pertain to the plan benefits pertaining to the EOB.
  • Works closely with third party payers to resolve unpaid claims in proving medical necessity of the patient's admission.
  • Works with HIM and PAS across the enterprise in resolving adverse benefit determinations.
  • Work closely with Appeals staff (Letter writers, Case Managers and Hearing specialists) in obtaining all pertinent information in a timely manner.
  • Performs duties as given by supervisor to fill in where needed: covering phones, sorting mail, scanning and filing or any other office function within the CAU.
  • Maintains and follows all HIPAA and confidentiality requirements.

Required Skills:

  • Demonstrated extensive knowledge in the health insurance industry (Commercial Insurances, Medicare, Medicaid); health claims billing and/or Third-Party contracts, minimum of two years experience in a specified area.
  • Demonstrated excellent analytical, fact-finding, problems solving and organizational skills as well as the ability to communicate, both verbally and in writing with staff, patients, and insurance plan administrators.
  • Demonstrated ability to work successfully in a team setting.

For this US-based position, the base pay range is $ $20.21 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

The healthcare system is always evolving — and it's up to us to use our shared expertise to find new solutions that can keep up. On our growing team you'll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package. )

R1 RCM Inc. ("the Company") is dedicated to the fundamentals of equal employment opportunity. The Company's employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person's age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at for assistance.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent )

To learn more, visit:

Visit us on Facebook )

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation and workflow orchestration.

Headquartered near Salt Lake City, Utah, R1 employs over 29,000 people globally and is traded on the Nasdaq stock exchange under the symbol "RCM."


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