Appeals Resolution Specialist

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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National Seating & Mobility

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1992

🏥 Healthcare

💼 Consulting

🏭 Manufacturing

Healthcare • Consulting • Manufacturing

National Seating & Mobility is a provider of mobility and accessibility solutions that offers customized power and manual wheelchairs, seating and positioning systems, stair and vehicle lifts, ramps, home modifications, service and repair, and home medical supplies. The company operates local locations and a support network delivering evaluations, preventive maintenance, financing, and personalized care to help people with disabilities live more independently.

📋 Description

• Review and manage assigned deferrals, denials, and appeals to determine the appropriate course of action and ensure timely resolution • Analyze payer correspondence, denial reasons, authorization requirements, medical documentation, and account history to identify underlying causes • Research payer policies, coverage criteria, contractual requirements, and applicable guidelines • Prepare accurate, persuasive appeal submissions with appropriate supporting documentation • Coordinate with internal departments to obtain missing or additional documentation • Communicate with payers, healthcare providers, and internal stakeholders to clarify requirements and resolve issues • Monitor appeal deadlines and payer response timeframes • Follow up throughout the appeal process and escalate complex or high-risk cases when necessary • Maintain complete and accurate documentation in applicable systems • Identify recurring denial and deferral trends and communicate findings to leadership • Partner with operational, funding, billing, training, and quality teams on process improvement • Serve as a subject matter expert on payer appeal processes, documentation requirements, and resolution strategies • Maintain current knowledge of payer policies, regulatory requirements, and organizational procedures • Meet productivity, quality, timeliness, and resolution performance expectations • Support special projects, audits, process improvements, and departmental initiatives • Work in a professional office environment using standard office equipment

🎯 Requirements

• High School Diploma or G.E.D. Required • Drug Test • Strong knowledge of healthcare payer requirements, authorization processes, denials, deferrals, and appeals • Ability to interpret payer policies, medical documentation, correspondence, and coverage requirements • Strong analytical and problem-solving skills • Excellent written communication skills for developing concise, well-supported appeal documentation • Strong verbal communication and interpersonal skills • Excellent organizational and time-management skills • Ability to manage multiple cases and deadlines simultaneously • High level of accuracy and attention to detail • Ability to work independently, exercise sound judgment, and appropriately escalate complex issues • Ability to identify trends and recommend process improvements • Proficiency with applicable payer portals, Microsoft Office applications, and other business technology • Must complete a drug test

🏖️ Benefits

• 401k • Company paid Long Term Disability • Tuition reimbursement • Array of benefits • Opportunity to build a meaningful career and make a lasting impact