Remote Appeals Specialist

Remote Appeals Specialist

Medical Appeals Specialist (Fully Remote)

Make a measurable impact by overturning denials, recovering missed revenue, and improving patient account outcomes. As a Medical Appeals Specialist, you’ll combine deep payer policy knowledge with analytical problem‑solving—owning complex research, writing strategic appeals, and driving high‑stakes follow‑ups to resolution.

• Research & Claims Audit – You’ll be assigned audits with varying volumes of accounts and will pivot priorities based on monthly team targets.
• Conduct horizontal audits (underpayments across a single payer) and vertical audits (similar denial reasons across multiple payers).
• Lead Zero Balance investigations: review EOBs/ERAs, identify denial reasons and contractual adjustments, and determine whether to appeal, rebill, or write off.
• Apply rigorous root‑cause analysis and strategic appeal tactics to overturn denials and recover revenue.
• Rebilling & Appeal Execution – Draft high‑quality appeal letters, confirm submission pathways, and generate “out‑the‑door” rebills for already‑vetted claims.
• Coordinate with payers and clients to ensure appeals are submitted accurately and promptly.
• High‑stakes Follow‑up – Perform advanced outbound follow‑ups on in‑process appeals—interpreting denial letters, validating payer responses, and deciding the best escalation and next steps.
• Make decisive phone calls to determine denial causes, the correct appeal destination, and whether escalation is warranted.

• Own the outcome:
  Make strategic recommendations on account disposition, surface trends to analysts, and help align team priorities to monthly goals.
• Quality + customer satisfaction:
  Balance meticulous audit work with meeting deadlines that serve client commitments.
• Communicate confidently:
  Heavy phone work—comfortable initiating calls to solve problems quickly.

• Work within client EHRs/EMRs, primarily Epic, Cerner, and Athena.

• HS diploma or GED.
• Minimum of 1+ year of Revenue Cycle Management experience specifically in appeals (denials research, root‑cause analysis, and complex payer follow‑ups over the phone).
• Direct experience with Zero Balance claims and payer denial codes, plus hands‑on complex appeals workflows.
• EMR/EHR experience (ideally Epic and Athena; Cerner exposure a plus).

• Third‑party/BPO/vendor background.
• Experience collaborating with analysts to interpret raw claims data and set audit strategy.

• Solve challenging problems that directly influence cash acceleration.
• Be part of a team that values quality over quantity while still hitting ambitious monthly goals.
• Grow your payer strategy acumen across multiple clients, EMRs, and payers.

Contract to Hire position based out of Englewood, CO. Fully remote.

The pay range for this position is $21.00 - $25.00/hr.

Benefits may include:

• Medical, dental & vision.
• Critical Illness, Accident, and Hospital.
• 401(k) Retirement Plan – Pre‑tax and Roth post‑tax contributions available.
• Life Insurance (Voluntary Life & AD&D for the employee and dependents).
• Short and long‑term disability.
• Health Spending Account (HSA).
• Transportation benefits.
• Employee Assistance Program.
• Time Off/Leave (PTO, Vacation or Sick Leave).

Final date to receive applications:
This position is anticipated to close on Jan 2, 2026.

We are an equal‑opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.