Appeals Specialist

Location: Remote

Salary: $50,000 per year

Company

hirify.global provides healthcare payment integrity solutions, including DRG validation, cost outlier, and readmission reviews.

What you will do

• Triage administrative appeals and determine the appropriate review workflow.
• Review payment disputes, reimbursement amounts, contract interpretations, and processing errors.
• Process clinical appeals when no new clinical information is submitted.
• Make appeal determinations according to client and organizational policies.
• Prepare clear, thorough, and accurate appeal responses.
• Coordinate with clinical review teams and stakeholders on new information, escalations, emerging matters, and trends.

Requirements

• Associate degree, preferably in a healthcare field, or equivalent education and relevant experience.
• At least one year of experience in healthcare claims, appeals, billing, or revenue cycle operations.
• Experience with administrative review of clinical appeals and a basic understanding of claims adjudication.
• Strong professional judgment, escalation awareness, analytical ability, and attention to detail.
• Excellent written and verbal communication skills, task prioritization, and ability to work independently.
• Proficiency in Outlook, Excel, and Word; ability to manage high-volume caseloads and strict deadlines.

Culture & Benefits

• Remote work with high-speed internet of 100 Mbps per person recommended.
• Dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
• Work requires extended computer and keyboard use.
• Fast-paced environment with frequent interruptions and time-sensitive priorities.