SLP (REMOTE)

Community Health Systems Professional Services Corporation•Franklin, TN

20h•Remote

About The Position

The Appeal Specialist II reviews, analyzes, and resolves insurance denials to support accurate reimbursement and regulatory compliance. The role logs and reviews denials for trend reporting, provides feedback to facilities, communicates payer updates to relevant stakeholders, and collaborates with internal teams to support timely and thorough appeal resolution and improve denial prevention and recovery processes. The position files medical necessity, level-of-care, and other in-scope clinical appeals using MCG, InterQual, CMS, and other applicable guidelines. It monitors appeal processes and denial trends, tracks and manages clinical denials, maintains payer-resource documentation, applies the CHS Appeal Process, and documents actions in Artiva, HMS, and other business office systems. The role also follows patient and hospital safety practices, protects patient-account confidentiality under HIPAA, provides professional customer service, and complies with policies, standards, and documentation requirements. The Payment Compliance and Contract Management (PCCM) team oversees the contract lifecycle, analyzes reimbursement discrepancies, improves revenue-cycle processes, and supports compliance with contractual terms and regulatory requirements. Community Health Systems operates healthcare delivery systems in 40 markets across 15 states, including 71 acute-care hospitals and more than 1,000 other sites of care.

Requirements

Associate degree in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy.
3–5 years of experience in clinical operations in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy.
Basic knowledge of medical billing, coding systems, and insurance claim processes.
Strong communication skills for interacting with insurance carriers, patient financial service units, and other departments.
Detail-oriented, with strong organizational and time-management skills to manage a high volume of appeals.
Proficiency with healthcare billing software and Google Suite.
One of the following credentials is required: RN state licensure and/or compact state licensure; Physical Therapist (PT); Registered Occupational Therapist (OT); or Speech Language Pathologist (SLP).

Nice To Haves

Bachelor’s degree in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy.
1–3 years of experience in claims processing, healthcare billing, or revenue cycle management.
1–3 years of utilization review and/or case management experience leveraging MCG or InterQual.

Responsibilities

File medical necessity and level-of-care appeals using MCG, InterQual, CMS, and other applicable guidelines.
File other in-scope clinical appeals, including appeals involving readmissions, experimental or investigational determinations, and coverage-based determinations.
Monitor clinical appeal processes for issues and trends and provide guidance and feedback to related departments.
Track and manage clinical denials using current tools, manuals, and training programs.
Identify denial patterns and trends and communicate them to appropriate personnel.
Maintain documentation regarding payer resources for denials and appeals processes.
Understand and apply the CHS Appeal Process for denied claims.
Follow and enforce accepted patient and hospital safety practices, report hazards, initiate appropriate action, and participate in safety instructional programs.
Provide professional customer service to patients, families, significant others, physicians, coworkers, and external vendors; respond promptly to inquiries and foster positive working relationships.
Document actions according to documentation standards in Artiva, HMS, and other required business office systems.
Understand and apply policy and procedure manuals and reference materials from insurance companies, regulatory organizations, and other applicable entities.
Protect the confidentiality of patient accounts by following HIPAA guidelines.
Maintain regular and reliable attendance and comply with all policies and standards.
Perform other duties as assigned.