Reimbursement Appeals Coordinator - Med Device

RxFunction•Eden Prairie, MN

3d•Onsite

About The Position

The Reimbursement Appeals Coordinator is responsible for processing and managing prior authorization and claim denial appeals for the Walkasins System across third-party payers. The Appeals Coordinator will gather supporting documentation, prepare and submit appeal packages, and track cases through resolution. This role requires strong attention to detail, comfort with payer communication, and the ability to manage multiple active cases simultaneously under strict deadlines.

Requirements

Minimum 3-5 years of third-party authorization experience with direct interaction with payers
Prior experience with payer appeals processes, including preparing and submitting appeal packages for prior authorization and claim denials
Strong written communication skills and ability to prepare clear, well-organized written correspondence
Exceptional attention to detail - appeal submissions must be accurate and complete; errors can result in lost appeal rights or delayed reimbursement
Comfortable with high-volume payer and patient phone contact as a routine part of the role
Working knowledge of payer coverage determination criteria, medical necessity standards, and appeals processes
Strong organizational skills and ability to manage multiple active cases simultaneously under strict filing deadlines
Extensive knowledge of medical insurance plan benefit structures
Ability to work independently as well as in a team environment
Proficiency in Microsoft Office software suite
Flexible and able to adapt to process and system changes in a growing environment

Nice To Haves

Associate's degree or higher preferred
3+ years specific industry experience, preferably in health insurance and/or durable medical equipment
Experience with medical device, DME, or DMEPOS reimbursement
Familiarity with prosthetic device benefit categories and HCPCS coding

Responsibilities

Review denial communications including EOBs and denial letters for prior authorization denials and claim denials to identify appeal opportunities and next steps
Gather and compile supporting documentation including clinical records and physician letters of medical necessity required for appeal submissions
Prepare appeal letters and packages ensuring submissions are accurate, complete, and compliant with payer requirements
Submit appeals through the appropriate channel for each payer including payer portals, fax, and mail, following payer-specific submission requirements
Contact payers by phone to confirm appeal processes, submission requirements, and case status
Track appeal deadlines across all active cases and ensure timely submission within payer-defined timeframes
Perform proactive follow up with payers on pending appeals to drive timely resolution
Manage cases through multiple levels of appeal including reconsideration, External Medical Review, and phone hearings as needed
Communicate appeal status and expected timelines to the sales team and patients
Contact patients as needed to provide updates on appeal status and next steps
Maintain accurate and detailed records of all appeal activity, submissions, and outcomes in internal systems
Surface denial trends and case patterns to senior team members
Handle patient information with discretion and maintain HIPAA compliance
Understand and comply with third-party payer and Medicare rules and regulations
Other duties as assigned