Appeals Specialist

Job Summary

The Appeals Specialist will be responsible for appealing all insurance denials and preparing relevant reports regarding trends in denials. This role requires the ability to ensure accurate and timely appeals to third-party payers in compliance with Managed Care contracts and government fee schedules.

Responsibilities

• Obtain, manipulate, and analyze data from various resources, including hospital/physician billing systems, external contract/claims management, and work with departmental personnel.

• Demonstrate a strong knowledge of clinical documentation, Medicare rules and regulations, and excellent interpersonal communication and problem-solving skills to gather and exchange data with key medical and third-party professionals.

• Prepare reports and trends analysis to support appeals and improve processes.

Requirements

• Certification in medical coding and billing is preferred.

• 2-3 years of experience in customer service, healthcare appeals processing, or the insurance industry.

• Strong knowledge of clinical documentation, Medicare rules and regulations, and excellent interpersonal communication and problem-solving skills.

What We Offer

Foundations for Living is committed to providing a work environment that is respectful, inclusive, and supportive of our teammates. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.

EEO Statement

Foundations for Living is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive work environment that values diversity and promotes equal opportunities for all teammates.

---