Job Description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You\'ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

We are seeking a detail-oriented and experienced Claims Appeals Specialist to join our team. The Claims Appeals Specialist will be responsible for managing the appeals process for denied claims.

This includes reviewing denied claims, researching and gathering supporting documentation, preparing appeal letters and communicating with the State of Vermont and healthcare provider to resolve claim appeals.

The ideal candidate will have an understanding of medical billing and coding practices, excellent analytical and problem-solving skills, and the ability to communicate effectively with various stakeholders.

Your role in our mission

• Review denied insurance claims to identify reasons for denial and determine the appropriate course of action.
• Conduct thorough research and gather necessary documentation to support appeal requests.
• Monitor appeal statuses and follow up to ensure timely resolution of claims appeals.
• Collaborate with internal teams, including coding specialists, to gather additional information or documentation as needed.
• Communicate with healthcare providers and the State of Vermont regarding appeal status, resolution, and next steps.
• Maintain accurate records of appeals, including documentation of correspondence and outcomes.

What we\'re looking for

• Detail-oriented
• Ability to multitask
• Highly organized
• Proficiency in Microsoft Excel and Outlook
• Oral and written communication skills.
• Flexibility

What you should expect in this role

• HYBRID

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The pay range for this position is $43,800.00 - $62,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You\'ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You\'ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our and visit our for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

Gainwell Technologies