Healthcare Claims Appeals Specialist in Lewiston, Idaho - #73491 | VanderHouwen

Description

Job Id: 73491

Healthcare Claims Appeals Specialist
Our client is seeking a Healthcare Claims Appeals Specialist to manage provider payment disputes and appeals from start to finish. This role is ideal for a detail-oriented problem solver with a background in healthcare claims who communicates clearly and diplomatically, and who thrives in a deadline-driven environment.

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

Healthcare Claims Appeals Specialist Responsibilities

• Own the full lifecycle of provider billing dispute and appeal cases, from intake through research, determination, and closure.
• Review claim coding, processing history, benefit plans, provider contracts, and medical and reimbursement policies to build well-supported appeal recommendations.
• Confirm that each appeal is eligible and timely, and document all findings and decisions accurately in the appropriate systems.
• Issue non-clinical determinations within department guidelines, and route cases to licensed clinical reviewers when medical judgment is needed.
• Work with coding specialists, nurses, physician reviewers, and appeal panels to reach timely, compliant decisions on complex cases.
• Prepare case files and correspondence for external review, and carry out the resulting decisions.
• Serve as a knowledgeable point of contact for members, providers, and their representatives, explaining the appeals process and the documentation needed.
• Manage an assigned caseload while meeting productivity, quality, and regulatory timeliness standards.
• Track appeals and contribute to reporting on volumes, outcomes, trends, and process improvement ideas.

Healthcare Claims Appeals Specialist Qualifications

• A minimum of 4 years of experience in healthcare claims, customer service, or clinical services, or an equivalent combination of education and experience.
• Working knowledge of medical terminology, anatomy, and medical coding, including CPT, diagnosis codes, and HCPCS.
• Solid understanding of health plan claims processing, benefits, eligibility, and reimbursement practices.
• Strong analytical and research skills, with the initiative to identify problems and carry out effective solutions.
• Excellent written and verbal communication skills, with the ability to explain complex medical and payment information in a diplomatic, professional, and confidential manner.
• Strong prioritization skills and the ability to shift between tasks while meeting strict deadlines and maintaining quality.
• Proficiency with Microsoft Word, Excel, and Outlook.
• High school diploma or GED required.
• Coding certification preferred.

Compensation: (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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