Appeals Specialist II
2 weeks ago
Job Summary
The Appeal Specialist II reviews, analyzes, and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. This role logs and reviews denials for trend reporting, provides feedback to facilities, and communicates payer updates to relevant stakeholders. The Appeal Specialist II collaborates with internal teams to ensure timely and thorough appeal resolution and supports initiatives that improve denial prevention and recovery processes.
As an Appeals Specialist II at Community Health Systems (CHS) - SSC Nashville, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision, insurance, and 401k.
Essential Functions
- Reviews and resolves pre-payment insurance denials in collaboration with follow-up teams.
- Coordinates with Denial Coordinators, Facility Denial Liaisons, and Managed Care Coordinators to ensure payer accountability and identify education opportunities.
- Provides feedback to facilities regarding denials resulting in retractions or reimbursement impacts.
- Monitors payer billing and coding updates and communicates changes to SSC and ancillary departments.
- Tracks and logs denials and appeal activity according to established documentation and reporting guidelines.
- Prepares and distributes reports summarizing appeal trends, project updates, and payer response activity.
- Recommends process improvements to enhance appeal efficiency and reduce recurring denials.
- Maintains up-to-date knowledge of payer policies, billing and coding practices, and reimbursement regulations.
- Utilizes practice management systems and maintains documentation of appeal activity in compliance with departmental standards.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
- This is a fully remote position.
- H.S. Diploma or GED required
- Bachelor's Degree in Nursing preferred
- 2-4 years of experience in healthcare revenue cycle or business office required
- 1-3 years of experience in healthcare insurance or medical billing preferred
- Proficiency in word processing, spreadsheet, and database applications.
- Working knowledge of billing, coding, and reimbursement principles.
- Strong analytical, research, and problem-solving skills.
- Ability to communicate effectively with payers, facility staff, and leadership.
- Strong organizational and documentation skills with attention to detail.
- Ability to work independently and manage multiple priorities in a fast-paced environment.
- Understanding of insurance claims processing and denial management workflows.
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.
The Shared Services Center - Nashville provides business office support functions like billing, insurance follow-up, call center customer service, data entry and more for hospitals and healthcare providers. But we're not only about work. We know employing a skilled and engaged team of professionals is vitally important to our success, so we make sure to offer competitive benefits, recognition programs, professional development opportunities and a fun and engaging team environment.
Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
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