Medical Appeal Specialist

Medical Appeal Specialist

PayerWatch, Inc. is a nationwide trusted leader in Healthcare revenue recovery. We use a twofold
approach to equip hospitals and health systems to achieve better outcomes at a lower cost. Our
Veracity Software and AppealMasters service help prevent and lower denials and reduce the cost of the
claims appeals process.

Job Title: Medical Appeal Specialist

Reports to: Supervisor, Appeal Operations

Job Type: Full Time, Non-Exempt

Purpose: This position is responsible for assisting with the processing incoming communication and documentation related to denial and audit cases from AppealMasters clients

Duties and Responsibilities

  • Input all task-required information into the database and complete assigned tasks per departmental policies.
  • Upload Proof of Delivery (POD) documents into a case file.
  • Bookmark medical records as assigned and upload them into a case file.
  • Prepare and print send packages for cases ensuring the timely delivery of the appeal to the payer. Send packages can be printed on paper, Compact Disk, or electronically sent via fax or e-delivery.
  • Demonstrate organizational and time management skills.
  • Maintain a high level of integrity and confidentiality/patient privacy (HIPAA). All information (written, verbal, electronic, etc.) that an employee encounters while working in a reimbursement environment is always confidential.
  • Ability to adjust to changing workloads by assisting teams and/or fellow employees as needed.
  • Making high-volume of phone calls and utilizing payer portals to obtain decisions as efficiently as possible.
  • Demonstrating a professional demeanor at all times when working with payers and clients alike.
  • Demonstrating the ability to prioritize your day to meet business needs.
  • Demonstrating superior organizational skills.
  • Maintaining a high level of integrity and discretion when handling protected health information (PHI) per HIPPA compliance regulations.
  • Processing medical reimbursements for denied commercial, government, and managed care claims as assigned.
  • Processing medical records.
  • Reviewing Explanation of Benefits (EOB) audit and denial letters and taking appropriate action via verbal or written appeal to challenge low payments and various denials.
  • Input all Payer disputes into the Veracity (PayerWatch proprietary software) daily.
  • Complete assigned tasks per departmental policies.
  • Contact payers to request needed documents and follow up on pending appeals.
  • Demonstrate organizational and time management skills to manage accounts.
  • Maintain a high level of integrity and confidentiality for patient privacy per HIPPA requirements. All information (written, verbal, electronic, etc.) that the Follow-up Specialist encounters while working in a reimbursement environment is ALWAYS confidential.
  • Perform other duties as assigned.

Working Conditions

The Appeal Coordinator works in our corporate office.

Required Education and Experience

Education: High School or equivalent

Minimum Experience: Two years of experience with Microsoft Office

Preferred Qualifications:

Education: Associate’s degree in a healthcare or business field (such as healthcare or business administration).

Preferred Experience:

  • Knowledge of business office systems.
  • Experience in a hospital revenue cycle.
  • Experience in data entry.
  • Experience working in a fast-paced, heavy volume work environment.
  • Experience working independently.

PayerWatch, Inc. provides equal employment opportunities to all employees and applicants for employment with regard to race, color, religion, gender, sexual orientation, national origin, age disability, genetic information, marital status, amnesty, or status as a covered veteran under applicable federal, state, and local laws.

How to Apply

Please submit a cover letter, CV or resume, and 2 HIPAA-compliant writing samples to Tracey Tomak at

All qualified applicants will receive consideration for employment, transfer or promotion without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, disability, or veteran status.