Oregon Appeals Specialist

Job Summary

A company is looking for an Appeals Specialist to support the resolution of provider billing disputes and member appeals.

Key Responsibilities

• Manage the intake, analysis, and resolution of provider billing disputes and appeals
• Research claims history and collaborate with clinical experts to support accurate determinations
• Document actions and communicate appeal outcomes clearly to members and providers

Required Qualifications

• High school diploma or GED required; at least 4 years of relevant experience
• Working knowledge of medical terminology, anatomy, and coding standards
• Intermediate proficiency with Microsoft Office; experience with health plan or claims systems preferred
• Coding certification (such as CPC through AAPC) preferred
• Previous experience in health insurance or a related healthcare setting is a plus