Appeals Specialist

Medical Data Systems Inc. is seeking a detail-oriented and motivated Insurance Appeals Specialist to join our insurance support and billing team. The ideal candidate will demonstrate professionalism, independence, and a strong understanding of insurance processes while thriving in a fast-paced environment.

• Perform insurance follow-up activities, including claim submission, claim status inquiries, and filing appeals for denied claims
• Process a high volume of detailed account information accurately and within established performance guidelines
• Navigate multiple systems to obtain insurance, contact, and attorney information as needed
• Support the prioritization of collections efforts by accurately updating account data and identifying next steps
• Maintain the highest level of confidentiality and adhere to all HIPAA regulations
• Apply hospital billing knowledge to carry out assigned duties efficiently

• Complete insurance-related tasks such as correcting and resubmitting claims, filing appeals, and contacting insurance companies, attorneys, or patients regarding outstanding balances
• Work assigned facility-specific queues, ensuring all accounts are updated with correct and complete information
• Participate in special projects or assignments as directed
• Assist colleagues and management by providing information or support related to insurance processes when needed

• 3-5 years of experience in a healthcare setting such as a hospital business office, surgery center, physician practice, or health insurance organization
• Strong communication skills, attention to detail, and self-motivation
• Proficient knowledge of insurance processes, including claim submission, claim denials, HCPCS/CPT/ICD-10 coding basics, and claim status inquiries
• Familiarity with Medicare/Medicaid, Commercial, Auto, Workers’ Compensation, Liability, Crime Victims, and State/Federal Insurance Programs
• Experience with medical billing and collection practices, business office procedures, and multi-system computer navigation
• Ability to type at least 55 words per minute
• High School Diploma or GED required; some college preferred

• Employment Type:
  
  Full-Time