Revenue Cycle Medical Billing Financial Appeal Writer

Revenue Cycle Medical Billing - Financial Appeal Writer

Work Location: Remote or In-Office

Hourly Pay: $18.50

(this position is bonus eligible)

JOB SUMMARY

The Financial Appeal Writer is responsible for managing the appeal process for denied and underpaid healthcare claims. This role involves reviewing claim denials, researching payment and coverage policies, and drafting evidence-based appeal letters to secure maximum reimbursement from insurance carriers. The specialist will collaborate with clinical and billing staff, analyze denial trends, and ensure timely submission of all appeals in compliance with regulatory requirements. The ultimate goal is to minimize lost revenue for the organization.

ESSENTIAL FUNCTIONS/DUTIES

• Review and analyze denials: Examine explanation of benefits (EOBs) and claim denial reasons to determine the root cause of non-payment or underpayment.
• Case management: Gather and organize necessary documentation, including medical records and billing information, to support the appeal.
• Draft appeals: Write detailed and compelling appeal letters that cite specific clinical guidelines, medical necessity arguments, or payer contract terms to support the claim.
• Identify trends: Analyze denial patterns and trends to identify systemic issues and report findings to management for process improvement.
• Communicate with stakeholders: Serve as a liaison between the healthcare organization, insurance carriers, and sometimes patients to clarify issues and provide updates on claim status.
• Ensure compliance: Stay current on all relevant healthcare regulations, coding updates, and payer-specific appeal guidelines.

QUALIFICATIONS

Required Experience:

• Minimum of three (3) years of experience in medical billing, accounts receivable, or a denials/appeals role within a healthcare setting.
• Minimum of three (3) years of customer service experience

Preferred Experience:

• Minimum of one (1) year call center experience

Required Skills:

• Expert knowledge: In-depth understanding of the healthcare revenue cycle, medical terminology, and insurance claim processes, including coding systems (CPT, ICD-10).
• Analytical skills: Strong critical thinking and problem-solving abilities to identify denial issues and determine the best course of action.
• Writing and communication skills: Exceptional written communication skills for drafting persuasive appeal letters, as well as excellent verbal communication for interacting with various stakeholders.
• Organizational skills: The ability to manage a high volume of cases, prioritize tasks, and meet strict deadlines.
• Technical proficiency: Experience with medical billing software and electronic health record (EHR) systems

Preferred Education:

• High school diploma
• GED
• Or significant, relevant work experience