The Role
The Appeals Specialist reviews denials and EOBs, develops appeal strategies, gathers necessary documentation, coordinates hearings, and meets filing deadlines while ensuring compliance with appeal processes.
Summary Generated by Built In
Responsibilities:
- Review assigned denials and EOB’s for appeal filing information. Gather any missing information.
- Review case history, payer history, and state requirements to determine appeal strategy.
- Obtain patient and/or physician consent and medical records when required by the insurance plan or state.
- Gather and fill out all special appeal or review forms.
- Create appeal letters, attach the materials referenced in the letter, and mail them.
- Coordinate phone hearings with the insurance company, patient, and physician.
- Comply with all 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP’s.
- Meet appeal filing deadlines by completing assigned worklist tasks in a timely matter and/or reporting to management when assistance is needed to complete the tasks.
- Report all insurance company or state requirements and denial trend changes to the Team Leader and Reimbursement Manager.
- Participate in team and appeal meetings by sharing the details of cases worked.
- Act as a backup on answering incoming telephone calls as needed.
- May undertake special projects assigned by the Team Leader or Reimbursement Manager.
- Ability to meet predetermined Productivity Goals based on the level of Appeal.
- Ability to meet Quality Standard in place (90% or greater).
- Other duties as assigned.
Qualifications:
- High School diploma or GED
- Minimum of four years health insurance billing experience
- Knowledge of managed care industry including payer structures, administrative rules, and government payers
- Proficient in all aspects of reimbursement
- Ability to maintain confidentiality
- Detail oriented
- Possess excellent written and verbal communication skills
- Able to establish priorities, work independently, and proceed with objectives without supervision.
- Proficient in using Microsoft Excel and Word
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
Skills Required
- High School diploma or GED
- Minimum of four years health insurance billing experience
- Knowledge of managed care industry
- Proficient in all aspects of reimbursement
- Ability to maintain confidentiality
- Detail oriented
- Possess excellent written and verbal communication skills
- Able to establish priorities and work independently
- Proficient in using Microsoft Excel and Word
Quadax Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Quadax and has not been reviewed or approved by Quadax.
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Leave & Time Off Breadth — PTO, holidays, and short-errand flex time indicate a broad time-off offering. Access to time off is often seen as a meaningful offset to lighter cash compensation.
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Retirement Support — A 401(k) with company match is part of the package. This is highlighted as a valued component even when cash pay is viewed as moderate.
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Wellbeing & Lifestyle Benefits — Wellness initiatives, employee discounts, and community programs add lifestyle value. These perks contribute to a more rounded benefits experience.
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The Company
What We Do
Quadax is a healthcare revenue cycle technology and services company focused on making the business of healthcare run better. Quadax enables clients to collect more and enhance visibility into their business, allowing them to focus on their role in providing quality healthcare.
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