Appeals Specialist

Medical Data Systems Inc. is seeking a detail-oriented and motivated Insurance Appeals Specialist to join our insurance support and billing team. The ideal candidate will demonstrate professionalism, independence, and a strong understanding of insurance processes while thriving in a fast-paced environment.
Key Responsibilities
- Perform insurance follow-up activities, including claim submission, claim status inquiries, and filing appeals for denied claims.

- Process a high volume of detailed account information accurately and within established performance guidelines.

- Navigate multiple systems to obtain insurance, contact, and attorney information as needed.

- Support the prioritization of collections efforts by accurately updating account data and identifying next steps.

- Maintain the highest level of confidentiality and adhere to all HIPAA regulations.

- Apply hospital billing knowledge to carry out assigned duties efficiently.

Essential Duties
- Complete insurance-related tasks such as correcting and resubmitting claims, filing appeals, and contacting insurance companies, attorneys, or patients regarding outstanding balances.

- Work assigned facility-specific queues, ensuring all accounts are updated with correct and complete information.

- Participate in special projects or assignments as directed.

- Assist colleagues and management by providing information or support related to insurance processes when needed.

Qualifications
- 3-5 years of experience in a healthcare setting such as a hospital business office, surgery center, physician practice, or health insurance organization.

- Strong communication skills, attention to detail, and self-motivation.

- Proficient knowledge of insurance processes, including claim submission, claim denials, HCPCS/CPT/ICD-10 coding basics, and claim status inquiries.

- Familiarity with Medicare/Medicaid, Commercial, Auto, Workers’ Compensation, Liability, Crime Victims, and State/Federal Insurance Programs.

- Experience with medical billing and collection practices, business office procedures, and multi-system computer navigation.

- Ability to type at least 55 words per minute.

- High School Diploma or GED required; some college preferred.

Position Details -
Employment Type: Full-Time

Originally posted on Himalayas