Appeals Specialist

Job Description

REQUIREMENTS

• 3-5 years of experience in laboratory billing appeals.
• Strong understanding of insurance policies, healthcare regulations, medical terminology, and coding.
• Expertise in appeals process for major insurance plans, Medicaid, and Managed Medicaid.
• Ability to manage multiple tasks and prioritize effectively.
• Knowledge of industry regulations, including HIPAA.
• Experience with Xifin is a plus.
• Exceptional attention to detail and organizational abilities.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook, and Teams) for reporting and documentation.
• Ability to support EST hours.

RESPONSIBILITIES

• Review and analyze denied claims to determine the basis for denial and assess appeal potential.
• Communicate with healthcare providers and insurance representatives to gather necessary documentation for appeals.
• Ensure all payor required documentation is submitted with each appeal and tracked in billing system.
• Monitor and follow up on submitted appeals to ensure timely resolution.
• Apply healthcare regulations, payor policies, and coding guidelines to maintain compliance in the appeals process.
• Identify and analyze denial trends, recommending process improvements to reduce future denials.
• Research payor-specific appeal processes to ensure proper steps are followed.
• Collaborate with clinical teams, market access and insurances representatives to resolve appeals issues.
• Perform additional responsibilities as assigned while demonstrating company leadership attributes and supporting of the Mission and Values of the company.

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