Remote Appeals Specialist

Job Description:

Overview

We are seeking an experienced and detail-oriented Appeals Specialist to join our team. The Appeals Specialist will be responsible for managing the appeal process for denied or underpaid claims related to therapy services. This individual will work closely with insurance providers, healthcare providers, and internal teams to ensure accurate and timely resolution of claims, ensuring our patients and providers receive the appropriate reimbursement. This is a fully remote position! 

Why Choose HealthPro Heritage?

• Purpose-Driven Work: Be part of a mission-driven organization dedicated to compassionate care and innovative therapy solutions. 
• Growth Opportunities: Enjoy continuous learning and development opportunities tailored to support your professional growth.
• Collaborative Culture: Thrive in a supportive environment where teamwork, respect, and open communication are at the heart of everything we do.
• Commitment to Excellence: Join a team recognized for clinical expertise and commitment to delivering high-quality care and outcomes.
• Competitive Benefits Package: Enjoy competitive compensation along with a comprehensive benefits package designed with YOU in mind!

Join Us in Making a Difference

At HealthPro Heritage, we offer a fulfilling career where you can positively impact lives and achieve personal and professional growth. As a therapist-led, diverse organization, we provide clinical services across various settings, including nursing facilities, retirement communities, hospitals, home care, and pediatric schools and clinics. Join us to be part of a team that values your skills, listens to your input, and makes a meaningful difference in the community.

Responsibilities

• Claims Review & Analysis: Review denied, rejected, or underpaid insurance claims for therapy services, identifying reasons for denial and determining the appropriate course of action.
• Appeal Preparation & Submission: Prepare and submit well-documented appeals to insurance companies, including all necessary supporting documentation (e.g., clinical notes, treatment plans, and medical records) to substantiate claims.
• Collaboration with Providers: Work closely with therapists and other healthcare providers to gather information needed for the appeals process and clarify any inconsistencies or issues with claims.
• Insurance Follow-up: Maintain regular communication with insurance companies to track the status of pending appeals, resolve issues promptly, and follow up on delayed or outstanding payments.
• Documentation & Reporting: Maintain accurate records of all appeals and follow-up actions, ensuring compliance with company policies, insurance regulations, and deadlines.
• Compliance & Knowledge Management: Stay updated on insurance policies, coding guidelines, and state/federal regulations affecting reimbursement for therapy services. Ensure compliance with all relevant laws, regulations, and payer requirements.
• Problem Solving & Issue Resolution: Identify recurring claim issues or trends, working with management to implement process improvements or corrective actions to reduce denials and improve reimbursement rates.
• Customer Service: Address any inquiries or concerns from patients, providers, or insurance representatives related to the appeals process in a professional and courteous manner.

Qualifications

• Education: High school diploma or equivalent; Bachelor's degree in healthcare administration, business, or a related field preferred.
• Experience: 2+ years of experience in insurance billing, coding, or claims appeals, preferably in the healthcare or therapy industry.