Billing & Appeals Specialist in Lewiston, Idaho - #72938 | VanderHouwen

Description

Job Id: 72938

Billing & Appeals Specialist
Our client is seeking a Billing & Appeals Specialist to support complex provider billing dispute and appeal activities in a fast-paced healthcare environment. This role is ideal for a detail-oriented professional with experience navigating healthcare claims, reimbursement guidelines, and the Independent Dispute Resolution (IDR) process while delivering exceptional service and maintaining compliance with regulatory requirements. The successful candidate will collaborate across multiple teams to analyze appeals, coordinate reviews, and ensure timely, accurate resolutions.

This role is fully remote. Applicants must reside in Oregon, Washington, Idaho, or Utah and work PST hours.

Billing & Appeals Specialist Responsibilities

• Manage a high-volume caseload of provider billing disputes and appeals, ensuring all cases are processed accurately and within established regulatory and internal deadlines.
• Review claims, billing records, reimbursement policies, provider agreements, benefit plans, coding information, and applicable regulations to evaluate appeal requests and develop well-supported recommendations.
• Perform intake validation by confirming eligibility, filing requirements, contract provisions, and appeal timeliness while maintaining accurate documentation throughout the review process.
• Coordinate with coding specialists, clinical reviewers, and cross-functional stakeholders to facilitate non-clinical and clinical appeal reviews and support timely case resolution.
• Support the Independent Dispute Resolution (IDR) and external review processes by preparing case documentation, coordinating required materials, communicating with involved parties, and implementing final determinations.
• Communicate appeal outcomes and complex claims information clearly and professionally to providers, members, insurance partners, and authorized representatives.
• Maintain detailed records within internal systems, monitor appeal activity, and assist with reporting, trend analysis, compliance tracking, and process improvement initiatives.
• Serve as a knowledgeable resource on billing dispute procedures, appeal workflows, and reimbursement policies while supporting established departmental quality, productivity, and customer service standards.
• Provide backup support for team members and contribute to collaborative problem-solving across business units as needed.

Billing & Appeals Specialist Qualifications

• Demonstrated experience performing production-based healthcare appeals work, including hands-on experience with the Independent Dispute Resolution (IDR) process.
• At least four years of experience in healthcare claims, appeals, customer service, billing, clinical operations, or a related healthcare insurance environment, or an equivalent combination of education and experience.
• Strong understanding of medical terminology, anatomy, and healthcare coding, including CPT, ICD diagnosis, and HCPCS coding systems.
• Experience analyzing healthcare claims, reimbursement policies, provider contracts, benefit plans, and regulatory requirements.
• Excellent analytical, critical thinking, and problem-solving skills with the ability to research complex issues and make sound non-clinical recommendations.
• Strong verbal and written communication skills with the ability to explain complex reimbursement and claims information to a variety of audiences.
• Proficiency with Microsoft Office applications, including Word, Excel, and Outlook, along with the ability to quickly learn new systems and applications.
• Ability to manage multiple priorities, adapt to changing business needs, and consistently meet productivity, quality, and turnaround expectations.
• Demonstrated professionalism, confidentiality, and customer-focused approach when interacting with providers, members, and internal stakeholders.
• Professional coding certification is preferred.

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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