MR & Appeal Specialist I

Evoraa Healthcare • Peachtree City, GA

13d

About The Position

The Medical Record & Appeal Specialist is responsible for the accurate and timely follow up and tracking appeal status of medical records and appeals submitted to insurances. The role involves obtaining and meticulously reviewing patient medical records sent to ensure completeness, accuracy, and compliance with regulatory guidelines and payer requirements. The position necessitates maintaining current knowledge of healthcare regulations, coding guidelines, and payer policies to ensure all appeal documentation and processes adhere to established standards. Detailed records of all appeal submissions and communication with payers must be maintained, and reports on appeal outcomes and trends generated. Finally, the specialist identifies opportunities to enhance efficiency and effectiveness in the appeal processes to optimize revenue recovery.

Requirements

• High school diploma or GED required; associate degree preferred.
• 2+ years of experience in medical records or health information role.
• Strong working knowledge of EMR platforms and clinical documentation workflows.
• Familiarity with regulatory requirements and payer documentation standards.
• Demonstrated ability to resolve documentation discrepancies independently.

Nice To Haves

• Experience supporting internal audits or payer reviews is strongly preferred.

Responsibilities

• Systematically monitoring the status of submitted appeals, identifying pending claims and timelines for follow-up in the billing system and Monday.com.
• Initiating and conducting consistent follow-up communication with insurance payers to ascertain appeal adjudication status, resolve outstanding issues, and expedite payment resolution.
• Facilitating the resolution of appeal denials through persistent follow-up and escalating complex or unresolved cases to appropriate internal or external parties.
• Ensuring all follow-up activities adhere to current healthcare regulations, coding guidelines, and payer policies.
• Accurately documenting all follow-up actions, communications, and appeal outcomes; generating comprehensive reports on follow-up effectiveness and trends.
• Analyzing follow up processes to identify and implement improvements that enhance efficiency and maximize revenue recovery from appealed claims.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree