RCM- Appeals Specialist

PathGroup • Brentwood, TN

1d

About The Position

The Appeals Specialist prepares and submits appeal packages, ensuring compliance with payer policies and regulatory guidelines. Responsibilities include reviewing documentation for accurate appeal language, monitoring appeal status, and following up on outstanding cases. The role requires expertise in medical claims processing and effective collaboration with internal and external stakeholders to maintain precise documentation.

Responsibilities

• Prepare, document, and submit appeals for complex scenarios, ensuring appeals are well supported with clinical evidence, coding guidelines, and regulatory requirements.
• Coordinate appeal responses with business partners.
• Utilize applicable tools and resources to complete appeals by reviewing supporting documentation.
• Proactively address discrepancies between payer policies, regulatory standards, and internal processes to prevent future denials.
• Other duties as assigned.

What This Job Offers

• Education Level: No Education Listed
• Number of Employees: 501-1,000 employees