Medical Appeals & Denials Specialist

• They are handling the full cycle process of figuring out WHY a CLAIM was DENIED and from there RESEARCHING and figuring out WHAT needs to be done to get it into the appeals process

• They are dealing 99% of the time with insurance companies and Medicare/Medicaid

• HEAVY phones

• They do all the work until the actually appeals letter is sent out. When that letter is sent out another department takes over.

• They will work off of 6 proprietary systems, each unique to the client (hospital system) they are working with. Since they have an influx of new hospitals as clients this is what they will work on the majority of their days.

• Critical thinking skills are very important