Insurance Follow-Up & Appeal Specialist

Prosser Memorial Health•Prosser, WA

7d•$22 - $32

About The Position

The Insurance Follow-Up & Appeals Specialist is responsible for the timely and accurate resolution of unpaid, underpaid, and denied insurance claims. This role focuses on proactive payer follow-up, denial analysis, and appeal submission to ensure appropriate reimbursement in compliance with payer contracts, Medicare/Medicaid regulations, and organizational policies. The specialist serves as a subject-matter resource for complex payer issues and supports revenue integrity through detailed documentation, trend analysis, and collaboration with internal teams.

Requirements

High School Graduate or GED.
Minimum 1 year of insurance follow-up, denial management, or appeals experience in a healthcare revenue cycle setting.
Working knowledge of medical billing, insurance benefits, and EOB interpretation.
Experience with Medicare, Medicaid, and commercial payers preferred.
Strong analytical, organizational, and problem-solving skills.
Ability to communicate professionally and effectively, both verbally and in writing.

Nice To Haves

Experience in a Critical Access Hospital (CAH) or rural health setting.
Familiarity with Epic or similar hospital billing systems.
Knowledge of CPT, HCPCS, ICD-10, and basic payer contract concepts.
Prior experience preparing medical necessity or technical appeals.

Responsibilities

Timely and accurate resolution of unpaid, underpaid, and denied insurance claims.
Proactive payer follow-up.
Denial analysis and appeal submission.
Ensure appropriate reimbursement in compliance with payer contracts, Medicare/Medicaid regulations, and organizational policies.
Serve as a subject-matter resource for complex payer issues.
Support revenue integrity through detailed documentation, trend analysis, and collaboration with internal teams.