AppleOne has partnered with a local Healthcare manufacturing company to add an Appeals Specialist. The ideal candidate will manage the overall direction, coordination, and evaluation of accounts. Additionally, the Appeals Specialist will be responsible for all activities associated with requests for provider billing disputes and appeals including analysis, preparation, evaluation of prior determinations, coordination of clinical reviews if needed, and decision making.

Key Responsibilities:
• Validates appeal intake determinations regarding timeliness, member benefits, employer group, and provider contract provisions for each appeal. Documents information in appropriate system.
Process incoming payments accurately applying them to the appropriate customer accounts.
• Collects and catalogues supporting documentation and formulate an appeal recommendation.
• Manage computers programmed with accounting software to optimize workflow and record, store, and analyze information.
• Analyzes and reviews claim coding and claim processing history, medical policy and reimbursement policies, regulatory and legal requirements, benefit contracts, and/or provider contracts.
• Oversees set-up of appeals for external review organizations, including document collection and coordination, communication with all parties, and other responsibilities as an intermediary between the provider and the external review organization.
• Code documents according to company procedures and documents information in the appropriate system.
• Collaborates effectively with coding specialists, appeal nurses, physician reviewers, and others as necessary to reach timely decisions on appeals.

Qualifications:
• Experience in Finance/Accounting
• 2 – 4 years of experience in healthcare billing, coding, collections, payment processing, or denials management. Denials
• Strong analytical and problem-solving skills.
• Ability to work collaboratively with cross-functional teams.


EEO/AA Employer/Vet/Disabled

The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf