Apply on Employer Site

Advanced Recovery Specialists · 1 day ago

Workers' Compensation Appeals Manager

Edina, MN

Full-time

Hybrid

Senior Level

$90K/yr - $110K/yr

5+ years exp

Advanced Recovery Specialists is a rapidly growing national healthcare organization operating in 47 states. They are seeking a Workers’ Compensation Appeals Manager to oversee the appeals process for denied and underpaid claims, driving revenue through strategic partnerships and ensuring accountability in Appeals Management.

ManufacturingMedical DeviceWholesale

Responsibilities

Own the full lifecycle of denied and underpaid workers’ comp claims, from analysis to appeal to resolution

Build and submit compelling first-, second-, and third-level appeals using clinical documentation, statutes, payer policy, state specific rules, and state specific laws

Proactively follow up with adjusters, nurse case managers, TPAs, and payers to hold them accountable

Negotiate, escalate, and resolve issues with persistence and professionalism

Track deadlines, reconcile payments, and maintain meticulous documentation

Collaborate across billing, intake, and authorization teams to ensure airtight claim submissions

Use AI tools and data insights to streamline processes and identify trends in denials

Meet or exceed company benchmarks and goals for appeals timelines and successful appeals wins obtaining payments

Use company reporting and KPI’s to track and adjust your focus and efforts

Manage third party collections efforts and litigation processes and oversight on unpaid workers compensation claims

Assist in guiding our organization on updated policies and procedures state by state in getting higher levels of approval/payments and minimizing loses form unpaid claims

Qualification

Workers' compensation expertiseClaims managementNegotiation skillsState-specific regulationsInsurance industry knowledgeAppeals process managementProactive mindsetTech-savvyMulti-state experienceCommunication

Required

5–10 years of experience in workers' compensation billing, appeals, or A/R

High school diploma or equivalent required

Deep knowledge of state-specific workers' comp regulations, fee schedules, and payer protocols

Possesses a strong understanding of the insurance industry, including common practices and strategies used in claims management

A proactive, self-starting mindset with a drive to see things through to resolution

results-driven professional with a relentless commitment to excellence, someone who thrives in competitive environments, embraces challenges, and consistently pushes for top performance

Excellent written and verbal communication skills, you're clear, assertive, and professional

Tech-savvy with tools like Microsoft Office or Google Workspace