Appeal Support Specialist

About the role

The Appeal Support Specialist ensures complete and accurate appeals of denied claims are submitted to the payer in a timely manner according to payer guidelines. This role processes submissions for reconsiderations, redeterminations, appeals, resubmissions of previously submitted appeals, State Complaint letters, legal submissions to the Administrative Law Judge, and requests for Coordination of Benefits or Patient Consent letters.

The Appeal Support Specialist also serves as an appeal writer for non-clinical appeals that meet specific criteria.

Responsibilities

• Submit complete and accurate appeals of denied claims according to payer guidelines.
• Process submissions for reconsiderations, redeterminations, appeals, and resubmissions of previously submitted appeals.
• Prepare and submit State Complaint letters and legal submissions to the Administrative Law Judge.
• Handle requests for Coordination of Benefits or Patient Consent letters.
• Write non-clinical appeals that meet specific criteria.
• Maintain confidentiality of sensitive and confidential information.
• Manage documents, including sorting, filing, and records retention to ensure accurate records.

Requirements

• Knowledge of office procedures.
• Ability to maintain confidentiality of sensitive information.
• Skilled in document management, including sorting, filing, and records retention.
• Strong verbal and written communication skills.
• Ability to read, write, and follow instructions and flow chart protocols.
• Ability to maintain a calm and helpful attitude under stress and resolve issues appropriately.
• High attention to detail.

Skills

• Advanced computer skills, including typing, information security, electronic medical documentation, handheld scanning, and email.
• Proficient with MS Office suite (Word, Excel, PowerPoint).