Appeals & Denials Specialist
TEKsystems•Los Angeles, CA
•$25 - $25•Onsite
About The Position
The QI Appeals Technician will support the appeals and quality improvement team by assisting in the review and resolution of denied claims. This role works collaboratively with coordinators and cross-functional teams to identify root causes of denials, ensure accurate processing, and support compliance with payer and regulatory requirements. The ideal candidate brings a strong understanding of healthcare operations, including claims processing, prior authorizations, and medical terminology, along with excellent communication skills.
Requirements
- Experience in claims processing, medical billing, prior authorizations, or appeals
- Strong knowledge of medical terminology and healthcare workflows
- Experience reviewing insurance coverage, benefits, and EOBs
- Proficiency working within EMR systems
- Excellent written and verbal communication skills
Nice To Haves
- Experience working for a health plan or within a managed care environment
- Experience in care coordination or utilization management
- Familiarity with claims adjudication and authorization processes
Responsibilities
- Support the end-to-end appeals process, including intake, review, and follow-up on denied claims
- Analyze claims to identify errors or discrepancies that contributed to denials
- Review medical records, coverage determinations, and benefits to support appeals decisions
- Conduct insurance EOB (Explanation of Benefits) reviews to validate claim outcomes
- Perform medical billing follow-ups to ensure timely resolution of outstanding issues
- Utilize standardized writing templates to prepare clear and compliant appeal communications
- Collaborate with internal teams to ensure accurate documentation and process improvements
- Maintain thorough and organized records within EMR and related systems
Benefits
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Career Level
Senior
Education Level
No Education Listed
