Healthcare Appeals Specialist in Portland, Oregon - #72284 | VanderHouwen

Description

Job Id: 72284

Healthcare Appeals Specialist
Our client is seeking a detail-oriented and analytical Healthcare Appeals Specialist to support the full lifecycle of provider billing disputes and appeals. This individual will play a critical role in evaluating complex claims, coordinating reviews, and ensuring accurate, timely resolution in alignment with regulatory requirements and internal policies. The ideal candidate brings strong problem-solving skills, the ability to navigate ambiguity, and a customer-focused mindset when working with members, providers, and cross-functional teams.

This role is fully remote. Applicants must be located in Oregon, Washington, Utah, Or Idaho.

Healthcare Appeals Specialist Responsibilities

• Lead end-to-end processing of provider billing disputes and appeals, including intake validation, detailed analysis, decision support, and case closure.
• Conduct comprehensive reviews of claims, coding, medical policies, reimbursement guidelines, and contractual obligations to develop well-supported appeal recommendations.
• Collaborate with clinical reviewers, coding specialists, and internal stakeholders to ensure accurate and timely determinations for complex cases.
• Communicate appeal outcomes clearly and professionally to members, providers, and representatives, including preparing written correspondence and documentation.
• Coordinate external review processes, including case preparation, documentation submission, and implementation of final determinations.
• Maintain accurate and compliant documentation within internal systems while tracking appeal status, timelines, and outcomes.
• Manage a defined caseload while consistently meeting productivity, quality, and regulatory turnaround standards.
• Provide guidance and education to members and providers regarding the appeals process, requirements, and next steps.
• Identify trends, support reporting efforts, and contribute to process improvements to enhance operational efficiency and compliance.
• Serve as a subject matter resource for appeal policies, procedures, and non-clinical determinations as needed.

Healthcare Appeals Specialist Qualifications

• Minimum of 4 years of experience in healthcare claims, appeals, customer service, or clinical support, or an equivalent combination of education and experience.
• Strong knowledge of medical terminology, anatomy, and coding systems (e.g., CPT, ICD, HCPCS).
• Demonstrated ability to analyze complex information, research issues, and make sound, data-driven recommendations.
• Excellent written and verbal communication skills, with the ability to explain complex concepts in a clear and professional manner.
• Experience working with claims processing systems and proficiency in Microsoft Office tools (Word, Excel, Outlook).
• Ability to manage multiple priorities, adapt to changing workloads, and meet strict deadlines with a high level of accuracy.
• Strong interpersonal skills with the ability to collaborate effectively across teams and maintain professionalism in sensitive situations.
• High attention to detail and commitment to maintaining confidentiality and compliance standards.
• Coding certification preferred but not required.
• Ability to work Pacific Time Zone hours in a remote environment and maintain flexibility for occasional schedule changes or overtime.

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
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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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