Commercial Appeals Specialist

About the role

Koya is always looking for curious and passionate individuals to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. This role reports to the Manager, Appeals within the Reimbursement Operations Department and is full time, exempt, and remote.

Responsibilities

• Draft persuasive appeal letters to third-party payers using clinical documentation
• Review medical records and develop appeal strategies based on payer guidelines and case strength
• Advocate for patients denied coverage and educate payers on product benefits
• Collaborate with internal departments to ensure accurate processing of patient orders and payer decisions
• Communicate with patients regarding appeal status, required attestations, product use, and financial concerns
• Update case records and tasks in Salesforce; ensure accuracy and timeliness
• Maintain compliance with HIPAA and all regulatory requirements
• Support the development of internal workflows and best practices
• Ensure accuracy while meeting productivity and quality standards
• Perform other duties as assigned

Requirements

• High school diploma required; Associate’s or Bachelor’s degree preferred
• Minimum 3 years of experience in appeals and reimbursement processes
• Background in medical devices, healthcare reimbursement, or related field

Skills

• Strong knowledge of insurance processes and third-party payer requirements
• Excellent written and verbal communication skills, including appeal and patient correspondence
• High attention to detail with strong analytical and problem-solving abilities
• Ability to work independently and collaboratively in a fast-paced environment
• Proficient in navigating payer portals and Salesforce
• Demonstrated ability to multitask, prioritize, and meet deadlines under pressure

Core Competencies

• Communication & cultural competence
• Initiative & critical thinking
• Flexibility & adaptability
• Planning & organization
• Teamwork & collaboration

Tools and Technology

• Google Suite
• Microsoft Office Suite
• Adobe
• Salesforce CRM

Physical Functions and Work Environment

The employee is regularly required to talk or hear. The employee frequently uses hands or fingers; handles or feels objects, tools, or controls. The employee occasionally stands, walks, sits, and reaches with hands and arms, and must occasionally lift and/or move up to 25 pounds. Specific vision abilities required include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.

Pay

The pay range for this role is $55,000 - $60,000 USD per year.

Benefits

Koya offers a base + bonus compensation package and a competitive benefits program.