Patient Access Appeals Specialist

Pulivarthi Group LLC is a Global Staffing & IT Technology Solutions company, combining the expertise of its team and the culture of your company to provide world-class solutions to customers with the right talent. We serve large healthcare, financial services, and government entities in the U.S.

Job Title

Job Overview/Summary

Responsibilities

• Partner with internal teams to secure access support and drive effective pull-through with payers.
• Develop clear, compelling, and well-supported patient appeal letters aligned with payer policies.
• Thoroughly review medical records and documentation for completeness and identify missing information required for appeal submission.
• Stay current on payer coverage policies, patient eligibility requirements, and healthcare reform impacts affecting therapy access.
• Utilize applicable medical policies, clinical publications, and supporting documentation to strengthen appeal arguments.
• Maintain accurate case documentation and status updates.
• Ensure strict compliance with HIPAA and patient confidentiality requirements.
• Adhere to company Code of Conduct, industry compliance standards, and applicable governmental regulations.
• Represent the organization professionally while upholding ethical business practices.
• Perform other duties as assigned.

Primary Skills

• Insurance appeals and grievance management
• Medical record review and documentation analysis
• Payer policy interpretation
• Appeal letter development
• Healthcare compliance (HIPAA)
• Cross-functional collaboration

Secondary Skills (Good To Have)

• Knowledge of healthcare reimbursement processes
• Experience in medical device or therapy access support
• Familiarity with clinical publications and medical policy research
• Customer service and stakeholder communication expertise
• Intermediate to advanced computer skills

Qualifications

• Bachelor’s degree or equivalent experience preferred
• Experience in healthcare insurance appeals, reimbursement, or patient access services
• Strong written communication skills for drafting appeal letters
• Knowledge of payer coverage policies and medical necessity criteria
• Excellent organizational and time management skills
• Ability to work independently in a high-volume, deadline-driven environment
• Strong ethical standards and commitment to regulatory compliance

Benefits/Perks

• Competitive compensation
• Professional development opportunities
• Collaborative work environment
• Exposure to reimbursement strategy and healthcare policy
• Comprehensive benefits package

Equal Opportunity Statement

Pulivarthi Group is proud to be an equal opportunity employer. We are committed to building a diverse and inclusive culture and celebrate authenticity. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, disability, protected veteran status, or any other legally protected characteristics.