Healthcare Appeals Specialist (Remote) in Portland, Oregon - #73414 | VanderHouwen

Description

Job Id: 73414

Healthcare Appeals Specialist (Remote)
Our client is seeking a diplomatic, detail-driven communicator who thrives on untangling complex situations and turning them into clear, fair outcomes. The ideal candidate is a sharp analytical thinker who stays composed under tight deadlines, builds trust with providers and members alike, and enjoys being a courteous advocate while working collaboratively across teams.

This role is fully remote. Applicants must reside in Oregon, Washington, Idaho, Utah, or North Dakota.

Healthcare Appeals Specialist (Remote) Responsibilities

• Review and validate incoming provider billing disputes and appeals for timeliness, benefit eligibility, and contract provisions.
• Analyze claim coding, processing history, and applicable policies, contracts, and regulations to formulate well-supported appeal recommendations.
• Make non-clinical appeal determinations, and coordinate clinical review with licensed health professionals when needed.
• Communicate decisions clearly to members, providers, and their representatives, while guiding them through the appeals process.
• Manage a defined caseload, track appeals in internal systems, and coordinate external review submissions while meeting strict compliance timelines.

Healthcare Appeals Specialist (Remote) Qualifications

• High school diploma or GED with 4+ years of experience in health plan customer service, claims, or clinical services, or an equivalent combination of education and experience.
• Working knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCS); coding certification is preferred.
• Familiarity with claims processing and clinical services operations.
• Excellent verbal and written communication skills, with the ability to explain complex medical and reimbursement information diplomatically and persuasively.
• Strong analytical and prioritization skills, with proficiency in Microsoft Word, Excel, and Outlook, and the flexibility to shift between tasks while maintaining confidentiality and quality.

Compensation: $28-$33/hr. (DOE)

VanderHouwen Contractors Enjoy Exceptional Benefit Perks!
As an eligible contract employee with VanderHouwen, you’ll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.

Meet VanderHouwen
What kind of recruiter do you see yourself working with? One who prioritizes your best interest, no matter what? VanderHouwen does, and we’re in it for the long game! Our recruiters focus on YOU, building meaningful, long-term relationships while developing a deep understanding of companies’ staffing needs and workplace cultures. This approach helps us find an ideal job match that aligns with your unique career aspirations and goals.

VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career!

VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.

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