Appeals Creation Specialist

ROLE SUMMARY

The Intersect Group is seeking an Appeals Creation Specialist to support a high performing Denials Management team. This role is responsible for researching denied claims, developing compelling payer appeals, and ensuring submissions meet payer requirements, regulatory standards, and filing deadlines.

The ideal candidate combines strong analytical capabilities with exceptional written communication skills to create effective appeal strategies and documentation. By identifying reimbursement opportunities and submitting high quality appeals, this individual will play a critical role in maximizing revenue recovery, reducing accounts receivable aging, and minimizing revenue leakage.

KEY RESPONSIBILITIES

• Review denied claims, supporting documentation, and payer correspondence to determine appropriate appeal strategies

• Draft clear, persuasive, and compliant appeal letters tailored to payer specific guidelines and requirements

• Incorporate clinical documentation, coding standards, contract language, and regulatory references into appeal submissions

• Ensure appeals are submitted accurately and within established payer filing deadlines

• Research insurance benefits, claim status information, and reimbursement issues to support appeal development

• Contact insurance carriers when necessary to obtain information, investigate claim status, and resolve reimbursement questions

• Maintain detailed and accurate documentation of appeal activities, communications, and actions taken

• Manage assigned workloads independently while meeting productivity, quality, and turnaround expectations

KEY REQUIREMENTS

• High school diploma or equivalent required

• Experience in healthcare revenue cycle management, denials management, appeals processing, or insurance claims preferred

• Strong understanding of insurance carriers, payer guidelines, Explanation of Benefits documentation, and denial codes

• Ability to interpret clinical documentation, insurance information, and reimbursement guidelines

• Experience working with electronic medical records systems such as Epic or similar healthcare platforms preferred

• Strong written communication skills with the ability to draft professional, persuasive, and compliant appeal letters

• Excellent verbal communication skills and professional telephone etiquette

• Strong organizational, documentation, and time management skills

• Ability to manage multiple priorities while maintaining accuracy and attention to detail

• Demonstrated ability to work independently in a fast paced, metrics driven environment

• Adaptability, critical thinking, and a commitment to continuous learning and professional growth

PREFERRED QUALIFICATIONS

• Bachelor's degree or equivalent combination of education and professional experience

• Experience working across multiple healthcare service lines

• Familiarity with productivity and quality driven operational environments

• Previous remote work experience within a structured and performance focused setting

• Knowledge of healthcare compliance requirements including HIPAA and confidentiality standards

WHAT SUCCESS LOOKS LIKE

• Developing accurate and effective appeals that improve reimbursement outcomes

• Consistently meeting appeal filing deadlines and quality expectations

• Maintaining comprehensive documentation and compliance with payer requirements

• Supporting reductions in denied claims and accounts receivable aging

• Contributing to revenue recovery efforts while maintaining high productivity standards

WHY JOIN THIS OPPORTUNITY

• Fully remote opportunity with a Monday through Friday schedule

• Direct impact on revenue cycle performance and financial recovery initiatives

• Collaborative team environment focused on professional development and continuous improvement

• Opportunity to expand expertise in denials management, appeals strategy, and healthcare reimbursement

• Stable and growing healthcare services environment with meaningful career growth potential