Insurance Appeals Representative

Insurance Appeals Representative


Job Details

Posted10 Days Ago
LocationBellevue, Washington 98004
Job TypeContract
ExperienceMid Level


The Insurance Appeal Representative is responsible for timely follow up on denied/outstanding claims ensuring payments for medical services are received in a timely manner. Insurance Appeal Representative may also function as an intermediary between healthcare providers, clients and health insurance companies.


  • -Analyze outstanding balances with insurance payers to determine appropriate course of action. Handle accounts receivable follow-up
  • -Demonstrate thorough knowledge of payer claims requirements and CMS 1500 requirements by payer, computer capabilities as related to claims production, and medical records input as they affect claims.
  • -Appeal denials with the appropriate documentation per the medical insurance carrier's requirements, and write the appeals letters when necessary.
  • -Following up directly with commercial insurance companies to process claim denials and appeals
  • -Handle an average of 50 accounts per day
  • -Using EPIC to document all claims
  • - Interpret and communicate information regarding credit policies and procedures, billing practices, and out-of-pocket patient responsibility to patients, physicians, and clinic staff.
  • - Handle phone, mail, and personal inquiries from and regarding patient accounts promptly, efficiently, and courteously. Follow through on all issues identified as requiring action as a result of inquiry.

Required Qualifications:

  • CPC and ICD-10
  • At least two years of processing denials and insurance follow up experience
  • Analytical skills

Preferred Qualifications:

  • EPIC experience
  • -Appeals experience
  • Candidates can come from a smaller clinics. They are looking for someone who enjoys insurance follow up and conducting research on how to best collect on the claims.