Revenue Cycle Specialist - Appeals

Revenue Cycle Specialist - Appeals

Location: Remote

Schedule: Full-Time, 40 hours/week

Pay: $23-$24 per hour DOE

Position Summary

The Revenue Cycle Specialist - Appeals supports the medical appeals and denials process by ensuring timely, accurate, and welldocumented responses to Medicare Administrative Contractors (MACs) and other payors. This role requires strong analytical skills, excellent written communication, and the ability to craft effective appeal letters grounded in reimbursement policy and medical necessity.

Essential Duties & Responsibilities

* Access, monitor, and retrieve documents from MAC and payor portals.

* Track documentation related to ADRs, TPE reviews, and other appeal types.

* Review documents for completeness, clarity, and responsiveness before submission.

* Communicate with operations, hospitals, and other care providers to obtain required records.

* Write medical necessity summaries and appeal letters specific to each case.

* Appeal carrier denials using policies, contracts, and medical records.

* Prioritize and manage a high volume of work while meeting deadlines.

* Respond to MAC and payor inquiries via phone, email, or fax.

* Identify denial trends and report findings to management.

* Recommend process improvements to enhance departmental efficiency.

* Complete required reports and assist with special projects.

Qualifications

Education / Licensing / Certification:

* High school diploma or GED required

* Nurse or EMT/Paramedic credentials preferred

* Certified Ambulance Coder (CAC) preferred

Experience:

* Minimum 1 year of medical billing experience required

* Minimum 1 year of experience with Microsoft Office, Smartsheet, and Adobe required

* Experience with ambulance coding and appeals highly desirable

* Experience navigating websites required

* Must type at least 45 WPM; 10key proficiency required

Knowledge & Skills:

* Advanced verbal and written communication skills required

* Ability to handle highvolume workloads with speed and accuracy required

* Knowledge of medical terminology and ICD-10 coding required

* Knowledge of HCPCS coding desired

* Knowledge of CMS guidelines preferred

* Experience with Medicare, Medicaid, HMO, and PPO appeals desired