As an Appeals Negotiator, you will be responsible for managing the appeals process for denied or underpaid medical claims. Your role will involve advocating on behalf of healthcare providers to challenge decisions made by insurance companies or payers and negotiate for fair reimbursement.

Responsibilities:

• Review denied or underpaid medical claims to understand the reasons for the denial or reduced reimbursement.

• Gather relevant documentation and information to support the appeal, including medical records, billing codes, and payer policies.

• Draft appeal letters or forms outlining the basis for the appeal and present evidence to support the provider's position.

• Communicate with insurance companies or payers to discuss the appeal and negotiate for a favorable resolution.

• Follow up on the status of appeals and provide updates to the provider or relevant stakeholders.

• Ensure compliance with regulatory requirements and payer guidelines throughout the appeals process.

• Collaborate with internal teams, such as billing specialists, coders, and clinicians, to gather necessary information and strengthen the appeal.

• Maintain accurate records of appeals and related correspondence for documentation and reporting purposes.

Qualifications:

• Bachelor's degree in a relevant field preferred.

• Previous experience in medical claims management, healthcare administration, or a related area.

• Strong understanding of medical billing processes and insurance regulations.

• Excellent communication and negotiation skills.

• Detail-oriented with the ability to analyze complex medical claims.

• Proficiency in gathering and interpreting medical data and documentation.

• Familiarity with regulatory requirements and payer guidelines.

• Ability to work independently and collaborate effectively with internal teams.

• Strong organizational skills and ability to manage multiple tasks simultaneously.

Monday to Friday | 6am -2pm | Onsite

This role is eligible for a $7,500 sign on bonus, and team quarterly bonuses

BENEFITS INCLUDE: 

• Medical, Dental and Vision plans 

• Life/AD&D Insurance Plans 

• Disability Plans 

• Flexible Spending Accounts 

• Employee Assistance Programs

• Critical Illness 

• Accident 

• Legal Services 

• Pet Insurance 

• Home and Auto

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance