Appeals Specialist

TEKsystems•Englewood, CO

9d•$21 - $25•Remote

About The Position

Make a measurable impact by overturning denials, recovering missed revenue, and improving patient account outcomes. As a Medical Appeals Specialist, you’ll combine deep payer policy knowledge with analytical problem‑solving—owning complex research, writing strategic appeals, and driving high‑stakes follow‑ups to resolution.

Requirements

HS diploma or GED
Minimum of 1+ year of Revenue Cycle Management experience specifically in appeals (denials research, root‑cause analysis, and complex payer follow‑ups over the phone)
Direct experience with Zero Balance claims and payer denial codes, plus hands‑on complex appeals workflows
EMR/EHR experience (ideally Epic and Athena; Cerner exposure a plus)

Nice To Haves

Third‑party/BPO/vendor background
Experience collaborating with analysts to interpret raw claims data and set audit strategy

Responsibilities

Research & Claims Audit
Conduct horizontal audits (underpayments across a single payer) and vertical audits (similar denial reasons across multiple payers).
Lead Zero Balance investigations: review EOBs/ERAs, identify denial reasons and contractual adjustments, and determine whether to appeal, rebill, or write off.
Apply rigorous root‑cause analysis and strategic appeal tactics to overturn denials and recover revenue.
Rebilling & Appeal Execution
Draft high‑quality appeal letters, confirm submission pathways, and generate “out‑the‑door” rebills for already-vetted claims.
Coordinate with payers and clients to ensure appeals are submitted accurately and promptly.
High‑stakes Follow‑up
Perform advanced outbound follow‑ups on in‑process appeals—interpreting denial letters, validating payer responses, and deciding the best escalation and next steps.
Make decisive phone calls to determine denial causes, the correct appeal destination, and whether escalation is warranted.
Own the outcome: Make strategic recommendations on account disposition, surface trends to analysts, and help align team priorities to monthly goals.
Quality + customer satisfaction: Balance meticulous audit work with meeting deadlines that serve client commitments.
Communicate confidently: Very heavy phone work—comfortable initiating calls to solve problems quickly.