Appeals Coordinator (Healthcare Revenue Cycle) This role plays a critical part in maximizing reimbursement and protecting revenue through expert-level appeals and payer negotiations.
What You'll Do - Maximize reimbursement by identifying, documenting, and resolving contracted and non-contracted underpayments
- Draft and submit high-quality appeal letters supported by clinical documentation and regulatory standards
- Manage and resolve complex claim denials, including: Medical necessity, Usual & customary reductions, Not-to-closest-facility rulings, Ground-level payment reductions
- Build and maintain strong working relationships with commercial, Medicare, Managed Care, and Workers' Comp payers
- Research statutes, payer policies, and regulatory guidelines to support appeals
- Partner with Patient Financial Services leadership to improve workflows and outcomes
- Identify trends and recommend process improvements across revenue cycle operations
- Represent the organization with a professional, compliant, and customer-focused approach
Required Qualifications - High School Diploma or GED (Bachelor's degree preferred)
- 5+ years of medical billing experience (EMS, emergency, or surgical billing strongly preferred)
- 3+ years of direct appeals writing and payer negotiation experience
- Experience with commercial and non-contracted commercial payers
- Strong knowledge of Medicare, Managed Care, and Workers' Compensation
- Proven ability to interpret compliance, regulatory, and payer requirements
- Demonstrated success drafting professional, persuasive appeal letters
- Solid understanding of: Patient account systems, Revenue management processes, Workflow systems and optimization
- Advanced written and verbal communication skills
- Ability to work independently while collaborating effectively with cross-functional teams
Pay Details: $53,000.00 to $65,000.00 per year
Search managed by: Joanna Calderon
Equal Opportunity Employer/Veterans/Disabled
Military connected talent encouraged to apply
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The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
- The California Fair Chance Act
- Los Angeles City Fair Chance Ordinance
- Los Angeles County Fair Chance Ordinance for Employers
- San Francisco Fair Chance Ordinance
Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
