Commercial Appeals Specialist Job Seattle area,Washington USA,Healthcare

Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. We offer a base + bonus compensation package, and a competitive benefits program.

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Job Summary

The Commercial Appeals Specialist is responsible for securing reimbursement from third-party payers by developing persuasive appeal letters and navigating complex insurance processes. This role involves reviewing clinical documentation, educating payers on product benefits, and supporting patients through the appeals process to ensure optimal coverage outcomes.

This role reports to the Manager, Appeals within the Reimbursement Operations Department. The role is full time, exempt and will work remotely.

Essential Duties and Responsibilities

Draft persuasive appeal letters to third-party payers using clinical documentation
Review medical records and develop appeal strategies based on payer guidelines and case strength
Advocate for patients denied coverage and educate payers on product benefits
Collaborate with internal departments to ensure accurate processing of patient orders and payer decisions
Communicate with patients regarding appeal status, required attestations, product use, and financial concerns
Update case records and tasks in Salesforce; ensure accuracy and timeliness
Maintain compliance with HIPAA and all regulatory requirements
Support the development of internal workflows and best practices
Ensure accuracy while meeting productivity and quality standards
Perform other duties as assigned

Minimum Qualifications

Education, Experience and Training

High school diploma required;
Associate’s or Bachelor’s degree preferred
Minimum 3 years of experience in appeals and reimbursement processes
Background in medical devices, healthcare reimbursement, or related field

Knowledge,

Skills and Abilities

Strong knowledge of insurance processes and third-party payer requirements
Excellent written and verbal communication skills, including appeal and patient correspondence
High attention to detail with strong analytical and problem-solving abilities
Ability to work independently and collaboratively in a fast-paced environment
Proficient in navigating payer portals and Salesforce
Demonstrated ability to multitask, prioritize, and meet deadlines under pressure
Communication & cultural competence
Initiative & critical thinking
Flexibility & adaptability
Planning & organization

Tools and Technology Physical Functions and Work Environment

The physical functions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.

While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus.

The noise level in the work environment is usually low to moderate.

Note

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any Koya manager authorized to…