Healthcare Claims Appeals Specialist in Portland, Oregon - #72285 | VanderHouwen

Description

Job Id: 72285

Healthcare Claims Appeals Specialist
Our client is seeking a detail-oriented and analytical Healthcare Claims Appeals Specialist to support the review and resolution of complex provider billing disputes and appeals. This individual will play a key role in evaluating claims, interpreting benefit and contract guidelines, and coordinating across clinical and operational teams to ensure accurate, timely outcomes. The ideal candidate is a strong communicator who can navigate sensitive situations while maintaining a high level of accuracy and professionalism.

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

Healthcare Claims Appeals Specialist Responsibilities

• Review and analyze provider billing disputes and appeals, including claims history, coding, reimbursement policies, and contractual guidelines.
• Validate appeal intake details such as timeliness, eligibility, and applicable benefit or provider contract provisions.
• Develop well-supported appeal recommendations by gathering documentation, researching policies, and applying regulatory requirements.
• Coordinate with clinical reviewers, coding specialists, and other stakeholders to support non-clinical and clinical appeal determinations.
• Communicate appeal decisions clearly and professionally to providers, members, and authorized representatives.
• Manage and track a caseload of appeals, ensuring all timelines, quality standards, and compliance requirements are consistently met.
• Facilitate external review processes, including documentation preparation, coordination with third-party reviewers, and implementation of final determinations.
• Provide education and guidance to internal and external stakeholders regarding appeal processes, claims, and benefit interpretation.
• Maintain accurate and thorough documentation within internal systems and contribute to reporting and process improvement initiatives.
• Support adherence to internal policies, regulatory standards, and customer-focused service expectations.

Healthcare Claims Appeals Specialist Qualifications

• 4+ years of experience in healthcare claims, appeals, customer service, or clinical operations, or an equivalent combination of education and experience.
• Strong knowledge of medical terminology, anatomy, and coding systems such as CPT, ICD (DX), and HCPCS.
• Coding certification strongly preferred.
• Proven ability to analyze complex claims issues, interpret policies, and develop effective, compliant solutions.
• Excellent written and verbal communication skills, with the ability to explain complex information clearly and diplomatically.
• 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 without sacrificing quality.
• Strong interpersonal skills with a customer-focused mindset and ability to handle sensitive situations with professionalism and confidentiality.
• Demonstrated collaboration skills, with experience working cross-functionally in a team-oriented environment.
• Self-motivated with strong attention to detail, organizational skills, and a proactive approach to problem-solving.

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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