Medical Claim Appeals Specialist

Overview

Join our dynamic healthcare team as a Medical Claim Appeals Specialist, where your keen eye for detail and passion for accurate medical billing will make a meaningful impact. In this role, you will be responsible for reviewing, analyzing, and resolving denied or disputed insurance claims related to medical services. Your expertise will help ensure that healthcare providers receive rightful reimbursement while maintaining compliance with industry regulations. This position offers an energetic environment where your organizational skills and knowledge of medical coding and insurance processes will drive positive outcomes for patients and providers alike.

Responsibilities

• Review and analyze denied or disputed insurance claims to identify reasons for denial and determine appropriate appeal strategies
• Prepare and submit detailed appeal documentation to insurance carriers, ensuring all necessary medical records, documentation, and coding are included
• Verify insurance coverage, benefits, and eligibility through insurance verification processes prior to submitting appeals
• Maintain organized records of all claim correspondence, appeals, and supporting documentation using financial software and medical record systems
• Collaborate with healthcare providers to obtain accurate medical documentation, including ICD\-9, ICD\-10, CPT codes, HCPCS codes, DRG classifications, and other relevant medical coding details
• Stay current on workers' compensation law, Medicare policies, and updates in medical billing standards to ensure compliance during appeals
• Communicate effectively with insurance companies to follow up on pending claims and resolve discrepancies promptly

Requirements

• Prior clerical experience in a healthcare setting or medical office environment is preferred
• Strong organizational skills with the ability to manage multiple cases simultaneously in a fast\-paced environment
• Knowledge of medical terminology, ICD coding (ICD\-9 \& ICD\-10\), CPT coding, HCPCS codes, DRG classifications, and medical billing procedures
• Experience with filing and maintaining detailed records of claims and appeals
• Familiarity with insurance verification processes and understanding of workers' compensation law is advantageous
• Proficiency in using financial software and electronic medical record systems for documentation management
• Ability to interpret complex medical documentation accurately and ensure compliance with industry standards

* REQUIRED: Experience with interventional spine and pain management procedure denials.

Pay: From $24\.00 per hour

Benefits:

• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance
• Work from home

Experience:

• medical procedure denial and appeals: 5 years (Required)

Location:

• Nashville, TN 37207 (Required)

Work Location: Hybrid remote in Nashville, TN 37207