Full-Time Appeals Support Specialist

Appeals Support Representative role directly supports the Clinical Appeals Specialist. Full-time remote position, Monday through Friday, 8:00am-4:30pm EST or 8:30-5:00pm EST.

Responsibilities:

• Complete outbound calls to payers for status updates.
• Interact with third-party insurance representatives and review retro authorization and appeal status online.
• Track and confirm weekly status updates on appeal cases.
• Request, track, and receive payer correspondence (approvals, denials, etc.).
• Organize and scan payer determination letters in KIPU charting system and update the Clinical Appeals Specialist.
• Document final appeal outcomes and case details.
• Obtain patient/guardian signatures on consent forms.
• Submit retro authorization requests, support retro SCA projects, and follow up.
• Identify problem cases and escalate issues.
• Attend monthly UR Team and quarterly Denials meetings.
• Adhere to privacy and HIPAA guidelines.
• Perform/assist with special projects.

Qualifications:

• Associate's degree or High School Diploma + 5-7 years appeals/grievance experience; Bachelor's degree preferred.
• Ability to work 8:00am-4:30pm or 8:30am-5:00pm EST.
• Proficient with Zoom, Microsoft Teams, and strong Microsoft Office skills (Excel, Word, Outlook).
• Experience with insurance follow-up/appeals/grievances.
• Familiarity with medical billing, provider relations, healthcare office experience.
• Self-starter, strong attention to detail, multi-tasking, high organization, and excellent communication skills.
• Adaptable to changing situations, excellent customer service, strong analytical skills.

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