Appeals Specialist
Core
Review denied claims, identify root causes, and submit documented appeals to maximize reimbursement for specialized laboratory services.
Role type
Mid-level billing appeals specialist
Builds
Reimbursement for genomic and large-scale clinical testing services
Domain
Healthcare / Genomics / Medical Billing
Deliverable
client delivery
Required skills
Insurance policy analysis, healthcare regulations, medical terminology, coding guidelines, denial trend analysis, HIPAA compliance, payor-specific process research
Preferred skills
Xifin experience
Responsibilities
Analyze denied claims to determine basis for denial and assess appeal potential; Communicate with healthcare providers and insurance representatives to gather documentation; Ensure all payor required documentation is submitted and tracked; Monitor and follow up on submitted appeals; Apply healthcare regulations and coding guidelines to maintain compliance; Identify denial trends and recommend process improvements; Research payor-specific appeal processes
Seniority
Mid-level, hands-on IC