52 Limited ยท 1 day ago
Appeals Specialist
United States
Contract
Remote
Mid Level
$27/hr - $31/hr
4+ years exp52 Limited is a digital staffing agency focused on the creative and technology space, and they are seeking a Full Time, Contract Appeals Specialist I for their healthcare client. In this role, you will manage provider billing disputes and appeals, ensuring compliance with regulatory requirements and collaborating with various stakeholders to achieve timely resolution.
AdvertisingMarketing
Responsibilities
Intake, validate, and document appeal requests for timeliness, benefits, and contract provisions
Analyze claims coding, processing history, medical/reimbursement policies, and regulatory requirements
Collaborate with coding specialists, appeal nurses, and physician reviewers to reach determinations
Make non-clinical appeal decisions within business guidelines and prepare cases for clinical/external review as needed
Draft and issue determinations to members and providers, ensuring compliance and clarity
Track appeals in systems, generate reports, and identify trends for process improvement
Provide education and support to members, providers, and their representatives on the appeals process
Qualification
Required
High school diploma or GED and 4+ years of customer service, claims, or clinical services experience (or equivalent)
Excellent verbal and written communication skills
Intermediate computer skills (Microsoft Word, Excel, Outlook, EMR/claims systems)
Knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCs)
Strong analytical skills with the ability to research issues and recommend solutions
Able to prioritize and manage caseloads while meeting strict timelines
Professional, diplomatic, and detail-oriented, with a consumer-focused mindset
Preferred
Coding certification (CPC/AAPC) and prior health insurance or provider office experience
Benefits
Paid sick leave
Comprehensive health insurance
Voluntary benefits
Company
52 Limited
52 Limited is a resource company connecting creative and technology talent with leading brands, marketing departments.
11-50 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase