Medical Appeals Specialist (SCA)

Accountabilities

• • Receive, review, reconcile, and forward medical appeal documents and requests accurately and efficiently.
  • Ensure all appeal activities comply with applicable federal and state regulations, contractual requirements, and established organizational guidelines.
  • Process appeal documentation within required service levels while maintaining a consistently high standard of accuracy and quality.
  • Upload media and supporting documentation to appropriate accounts, verify successful uploads, and resolve issues when necessary.
  • Distribute designated media and appeal-related information to the appropriate internal departments.
  • Serve as a key point of contact between providers, external stakeholders, and internal teams involved in the appeals process.
  • Meet established daily and weekly production standards while maintaining accuracy and attention to detail.
  • Identify workflow inefficiencies and recommend process improvements that can increase operational efficiency, accuracy, and consistency.
  • Prioritize and manage multiple assignments effectively in a changing operational environment.
  • Complete additional administrative, operational, and appeals-related responsibilities as assigned by department leadership.
  • Collaborate with colleagues across locations and functions to resolve issues, address discrepancies, and develop practical solutions.

  Requirements

  • High school diploma or GED required.
  • At least 5 years of relevant office, administrative, healthcare, or support experience, ideally with progressively complex responsibilities.
  • Demonstrated knowledge of healthcare audits, medical appeals, claims processing, billing, recovery processes, and related operational practices.
  • Working knowledge of Medicare and Medicaid processes is strongly preferred.
  • Strong understanding of medical documentation and the ability to accurately review and handle sensitive information.
  • Intermediate proficiency with Microsoft Excel and Microsoft Word, including the ability to organize and manage operational information.
  • Excellent multitasking and prioritization skills, with the ability to manage competing deadlines and changing requirements.
  • Strong attention to detail and a demonstrated ability to maintain high-quality work while meeting strict production expectations.
  • Ability to work independently, take ownership of assigned workloads, and complete tasks efficiently with appropriate judgment.
  • Strong written and verbal business communication skills.
  • Professional, courteous, dependable, conscientious, and reliable approach to work.
  • Adaptability and willingness to adjust quickly to evolving business needs, processes, and priorities.
  • Strong problem-solving skills and a collaborative mindset, with the ability to work effectively with different teams and stakeholders.

  Benefits

  • $21.00 per hour base pay.
  • Fully remote work from anywhere in the United States.
  • Medical, dental, and vision insurance options.
  • Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
  • 401(k) retirement plan with company match.
  • Tuition reimbursement opportunities.
  • Additional health and wellness benefits and employee perks.
  • Flexible, trusting work environment designed to empower employees to perform at their best.
  • Opportunity to contribute to healthcare operations that focus on improving efficiency, transparency, and financial outcomes.