Appeals Specialist (Healthcare)

TL;DR

Appeals Specialist (Healthcare): Managing the review and submission of denied insurance claims for specialized laboratory services with an accent on maximizing reimbursement and ensuring regulatory compliance. Focus on analyzing denial trends, collaborating with clinical teams, and navigating complex payor policies to improve appeal success rates.

Location: Must be based in the United States and able to support EST hours.

Salary: $31.25 - $33.65 USD per hour (approx. $65,000 - $70,000 annually).

Company

hirify.global is a genomics company delivering personalized health insights to inform diagnosis and improve patient care through large-scale clinical data.

What you will do

• Review and analyze denied claims to determine the basis for denial and assess appeal potential.
• Communicate with healthcare providers and insurance representatives to gather necessary documentation.
• Ensure all payor-required documentation is submitted and tracked within the billing system.
• Monitor submitted appeals to ensure timely resolution and follow-up.
• Apply healthcare regulations and coding guidelines to maintain compliance.
• Identify denial trends and recommend process improvements to reduce future denials.

Requirements

• 3-5 years of experience in laboratory billing appeals.
• Must be based in the U.S. and able to support EST working hours.
• Strong understanding of insurance policies, healthcare regulations, and medical terminology.
• Expertise in appeals processes for major insurance plans, Medicaid, and Managed Medicaid.
• Knowledge of industry regulations, including HIPAA.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook, Teams).

Nice to have

• Experience with Xifin billing software.

Culture & Benefits

• Comprehensive health, dental, vision, and life insurance.
• 401k Retirement Savings Plan with company match.
• Employee Stock Purchase Plan.
• Up to 22 weeks of fully paid parental leave (U.S.).
• Up to $25K annually for fertility, adoption, or surrogacy support.
• Paid Time Off (PTO) and voluntary benefits.