Audit and Appeals Specialist

Audit and Appeals Specialist

Southwoods Health

Location:

Southwoods Executive Centre (Business Office), Boardman, Ohio

Employment Type:

Full‑Time (40 hours per week)

Southwoods Health is hiring an Audit and Appeals Specialist to work in our business office. The Specialist is responsible for recording, organizing, and compiling third‑party payer audits and corresponding appeals to ensure accurate documentation and timely responses. This role also serves as a key resource for second‑level appeals, working to overturn denials through detailed analysis of audit findings, medical records, coding, and payer policies.

• Record incoming third‑party payer audits and organize reviews and appeals to ensure they are performed in a timely manner.
• Assist with compiling documentation and write timely, compelling appeals to third‑party payers to overturn denials.
• Perform ongoing analysis to determine the root cause of denials and make recommendations for workflow or operational changes.
• Research and develop a solid understanding of payer requirements, including but not limited to filing limits, reimbursement policies, claim processing logic, and authorization requirements.
• Properly direct any problems with accounts where additional intervention is needed for resolution and timely corrections to accounts receivable balances.
• Perform other revenue cycle duties as assigned.

• Demonstrated hands‑on experience with payer audits, payment integrity reviews, and formal appeals across commercial, Medicare, and Medicaid payers.
• Strong understanding of CMS regulations, OIG guidance, and payer‑specific audit and appeal requirements.
• Familiarity with RAC, MAC, Medicare Advantage, and commercial payer audit processes.
• Effective communication skills and the ability to problem solve.
• Maintain professional demeanor at all times, demonstrating strong ethical and moral principles.
• Comprehensive knowledge of operational aspects of the revenue cycle and measures to take in resolving claim issues.

• Hours:
  
  Full‑time, 40 hours per week.
• Availability:
  No evenings or weekends required.

At Southwoods, it's not just about the treatment, but how you're treated.

For more information and to apply, please visit our website:

Seniority level:
Entry level

Employment type:

Full‑time

Job function:
Accounting / Auditing and Finance