Senior Appeals Specialist

A company is looking for a Senior Appeals Specialist to design and implement appeal strategies for optimizing reimbursement success and reducing claim denials.



Key Responsibilities

Develop and implement an appeals strategy to reduce denial rates and improve reimbursement outcomes
Conduct root-cause analysis of denied claims and create workflows and templates to enhance the appeals process
Collaborate with cross-functional teams to coordinate efforts and ensure compliance with regulatory changes and payer policies


Required Qualifications

Bachelor's degree with 5 years of experience in healthcare and/or life sciences
5+ years of experience in healthcare reimbursement, focusing on claims appeals and denials management
In-depth knowledge of medical billing and coding standards, including ICD-10 and CPT
Experience with revenue cycle management in a CLIA-certified laboratory or similar healthcare setting
Familiarity with healthcare software solutions and data visualization tools, such as Tableau or Power BI