Appeals Specialist - Hospital Billing, Underpayments
Overview
This role involves supporting healthcare providers by ensuring accurate, timely, and transparent reimbursement for services delivered. The position focuses on managing complex revenue cycle tasks including follow-up on underpaid claims, researching claim variances, drafting appeals, and reviewing claim details for discrepancies.
Responsibilities
- Follow up with insurance carriers on underpaid claims via phone and complete advised follow-up actions
- Research claim variances using hospital patient accounting systems such as EPIC, Meditech, Cerner, and Athena
- Draft appeals to insurance carriers for denied or underpaid claims
- Review claim details including coding, billing, and insurance information to identify discrepancies
- Process claims data through various pricing software
Requirements
- Strong knowledge of the healthcare industry
- Ability to troubleshoot and resolve claim submission errors
- Demonstrated attention to detail
- Excellent written and verbal communication skills
- Team-oriented and flexible
- Creative problem-solving skills
- High school diploma required
- Hospital billing experience required
Preferred Qualifications
- Bachelor's degree preferred
- Previous experience working from home
Work Environment
The work environment is representative of typical office settings where essential job functions are performed. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Additional Information
The listed duties are illustrative and not exhaustive. Other related duties may be assigned as necessary. If additional duties become a regular part of the role, a revised job description will be provided.
Equal Opportunity Statement
The employer is an Equal Opportunity Employer and does not discriminate based on age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, gender identity, military veteran status, or any other characteristic protected by law.