Insurance Follow-Up & Appeal Specialist

Job Summary

The Insurance Follow-Up & Appeals Specialist is responsible for the timely and accurate resolution of unpaid, underpaid, and denied insurance claims. This role focuses on proactive payer follow-up, denial analysis, and appeal submission to ensure appropriate reimbursement in compliance with payer contracts, Medicare/Medicaid regulations, and organizational policies. The specialist serves as a subject‑matter resource for complex payer issues and supports revenue integrity through detailed documentation, trend analysis, and collaboration with internal teams.

High School Graduate or GED. Minimum 1 year of insurance follow-up, denial management, or appeals experience in a healthcare revenue cycle setting. Working knowledge of medical billing, insurance benefits, and EOB interpretation. Experience with Medicare, Medicaid, and commercial payers preferred. Strong analytical, organizational, and problem‑solving skills. Ability to communicate professionally and effectively, both verbally and in writing.

Experience in a Critical Access Hospital (CAH) or rural health setting. Familiarity with Epic or similar hospital billing systems. Knowledge of CPT, HCPCS, ICD‑10, and basic payer contract concepts. Prior experience preparing medical necessity or technical appeals.

• Pay Range: $22.25-$32.25
• Excellent health, dental, and vision benefits
• Retirement plan with employer contributions
• Generous paid time off