Healthcare Claims Appeals Specialist (Remote) in Lewiston, Idaho - #73492 | VanderHouwen

Description

Job Id: 73492

Healthcare Claims Appeals Specialist (Remote)
Our client is seeking a Healthcare Claims Appeals Specialist (Remote) who is a sharp, analytical problem-solver with a talent for turning complex information into clear, compassionate communication. The ideal candidate is a diplomatic and persuasive advocate who stays composed under tight deadlines and thrives on resolving issues for members and providers. If you enjoy digging into the details and making a real difference for the people you serve, this role is for you.

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

Healthcare Claims Appeals Specialist Responsibilities

• Review and validate incoming provider billing disputes and appeals for timeliness, benefits, and contract provisions.
• Analyze claim coding, processing history, policies, and contracts to prepare well-supported appeal recommendations.
• Make non-clinical appeal determinations and coordinate clinical reviews with licensed health professionals when needed.
• Communicate decisions and explain the appeals process to members, providers, and their representatives with professionalism and care.
• Manage a defined caseload, prepare cases for external review, and accurately document and track all activity in appropriate systems.

Healthcare Claims Appeals Specialist Qualifications

• High school diploma or GED with a minimum of 4 years of experience in customer service, claims, or clinical services, or an equivalent combination of education and experience.
• Knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCS), with coding certification preferred.
• Familiarity with claims processing and clinical services operations.
• Intermediate proficiency in Microsoft Word, Excel, and Outlook.
• Excellent verbal and written communication skills, with the ability to prioritize work, meet strict timelines, and maintain confidentiality.

Compensation: $21-$28/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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