Healthcare Appeals Specialist

3 weeks ago


San Francisco, California, United States AAS Healthcare Staffing Full time
Denial Appeals Specialist

We are seeking a highly skilled Denial Appeals Specialist to join our team at AAS Healthcare Staffing in Brooklyn, NY. As a hospital liaison with third-party payers, you will play a critical role in reviewing denied claims, writing appeals, and retrospectively pre-certifying Medicaid, Medicare, and private insurance accounts.

Key Responsibilities:
  • Conduct thorough utilization chart reviews to identify areas for improvement
  • Analyze denial rationales to develop effective appeal strategies
  • Provide medical necessity appeal services to ensure compliance with Medicare guidelines
  • Audit patient records for retrospective pre-certification and identify opportunities for process improvement
  • Draft appeal letters and research relevant regulations to support appeals
Requirements:
  • BA/BS in Health Care Management or related field
  • Minimum 5 years of experience in medicine/clinical and/or denial/appeals management/utilization review
About Brooklyn:

Brooklyn is a vibrant and dynamic borough with a rich tapestry of culture, history, and community. As a Denial Appeals Specialist, you will have the opportunity to work in a fast-paced and rewarding environment, surrounded by a diverse and talented team.



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