Audit and Appeals Specialist

Southwoods Health • Boardman, OH

22d • Onsite

About The Position

Southwoods Health is hiring an Audit and Appeals Specialist to work in our business office. The Specialist is responsible for recording, organizing, and compiling third-party payer audits and corresponding appeals to ensure accurate documentation and timely responses. This role also serves as a key resource for second-level appeals, working to overturn denials through detailed analysis of audit findings, medical records, coding, and payer policies.

Requirements

• Demonstrated hands-on experience with payer audits, payment integrity reviews, and formal appeals across commercial, Medicare, and Medicaid payers.
• Strong understanding of CMS regulations, OIG guidance, and payer-specific audit and appeal requirements.
• Familiarity with RAC, MAC, Medicare Advantage, and commercial payer audit processes
• Effective communication skills and the ability to problem solve.
• Maintain professional demeanor at all times, demonstrating strong ethical and moral principles.
• Comprehensive knowledge of operational aspects of the revenue cycle and measures to take in resolving claim issues.

Responsibilities

• Record incoming third-party payer audits and organize reviews and appeals to ensure they are performed in a timely manner.
• Assist with compiling documentation and write timely, compelling appeals to third-party payers to overturn denials.
• Perform ongoing analysis to determine the root cause of denials and make recommendations for workflow or operational changes.
• Research and develop a solid understanding of payer requirements, including but not limited to filing limits, reimbursement policies, claim processing logic, and authorization requirements.
• Properly direct any problems with accounts where additional intervention is needed for resolution and timely corrections to accounts receivable balances.
• Perform other revenue cycle duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed