Claims Appeals Specialist/Meadville

Job Summary:

eKidzCare are seeking an assertive, detail-oriented Claims Appeals Specialist to join our healthcare billing team. In this critical role, you will manage the appeals process for denied or underpaid insurance claims. You will be responsible for analyzing denial reasons, compiling compelling appeals, tracking appeal progress, and working directly with insurance companies to resolve issues. This position requires someone who is not afraid to challenge decisions, is highly organized, and has a knack for problem-solving and persuasive communication. NOT A REMOTE POSITION

Key Responsibilities:

• Analyze denied or underpaid insurance claims to determine the cause of denial (e.g., coding errors, lack of documentation, medical necessity).

• Prepare and submit timely and accurate appeal letters with supporting documentation to insurance companies.

• Track the progress of submitted appeals and follow up regularly to ensure resolution within payer-specific timeframes.

• Communicate directly with insurance representatives to negotiate resolutions and advocate for claim reconsideration.

• Identify denial patterns and collaborate with clinical, coding, and administrative staff to implement proactive strategies to reduce future denials.

• Maintain accurate records of appeals activity, decisions, and outcomes in the system.

• Monitor changes in payer policies and guidelines that may affect claims and reimbursement.

• Provide regular reports on appeals status, outcomes, and trends to management.

Qualifications:

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in healthcare administration, billing, or related field preferred.

• 2+ years of experience in medical billing, claims, or appeals required.

• Strong understanding of insurance guidelines, coding principles (ICD-10, CPT, HCPCS), and EOBs.

• Exceptional organizational and time management skills.

• Excellent written and verbal communication skills, with a persuasive and assertive style.

• Ability to work independently and handle a high volume of work with accuracy and efficiency.

• Proficient with healthcare billing software and Microsoft Office Suite.

Ideal Candidate:

• Confident and assertive communicator who is comfortable challenging insurance decisions and advocating for reimbursement.

• Naturally analytical and enjoys getting to the bottom of complex problems.

• Highly organized, detail-oriented, and persistent in follow-through.

• Thrives in a fast-paced, deadline-driven environment and enjoys taking ownership of tasks.

Apply now to become part of a team where your drive, voice, and sharp eye for detail make a direct impact on revenue cycle performance.

*Pay rate is subject to change based on skills and experience* 

IND07

#zrcorp