Appeals Specialist – Appeals RnD

PrimEra Medical Technologies; Hyderabad; On-site; INR 900,000 - 1,300,000; Full time

Job summary

PrimEra Medical Technologies is seeking an Appeals Specialist for its Appeals RnD team. The role focuses on analyzing patient accounts, identifying opportunities for technical appeals, and researching payer guidelines and regulatory changes to enhance the appeals process.

Responsibilities include developing appeal strategies, collaborating with cross-functional teams, and driving data-driven improvements in revenue cycle management.

Qualifications

• Graduate in BDS/MBBS/PharmD with MBA/MPH/MHA.
• Strong analytical thinking and research acumen.
• Innovative problem-solving abilities for process improvements.
• Solid understanding of AR/RCM concepts, payer policies, and reimbursement methods.
• Familiarity with healthcare regulations and compliance.

Responsibilities

• Analyze patient accounts to determine suitability for appeals.
• Identify appeal opportunities based on payer guidelines and regulations.
• Develop and implement appeal strategies to maximize revenue recovery.
• Collaborate with operations, legal, and compliance teams to align appeal strategies.
• Monitor industry updates and regulatory changes affecting technical appeals.

Skills

Analytical thinking

Research acumen

Problem solving

AR & RCM knowledge

Healthcare compliance

Project coordination

Data interpretation

Reporting

Collaboration & communication

MS Office (Excel/PowerPoint)

Education

Bachelor's in BDS/MBBS/PharmD

MBA/MPH/MHA

Tools

None

Job description

Department: Accounts Receivable

Sub-Department: Appeals Research and Development

Job Summary:

Are you a critical thinker with a knack for problem-solving and process enhancement? Do you thrive in an analytical environment where research, strategy, and innovation drive impactful results? If so, we are looking for Appeals Specialists to join our Appeals RnD team.

As an Appeals Specialist, you will play a pivotal role in analyzing patient accounts, identifying opportunities for appeals, and researching industry updates, legal aspects, and strategic enhancements in the appeals process.

Your expertise will contribute to process optimization, operational efficiency, and long-term strategy planning within the appeals domain. This role is at the intersection of operations, process innovation, and healthcare regulatory strategy, making it a unique opportunity for professionals who enjoy diving deep into analytical solutions and influencing operational excellence.

Key Responsibilities:

Technical Appeals Analysis and Process Optimization

• Conduct in-depth analysis of patient accounts to determine eligibility for technical appeals.
• Identify potential appeal opportunities based on payer guidelines, claim denials, and compliance regulations.
• Develop and implement appeal strategies to maximize revenue recovery and ensure compliance with regulatory policies.
• Work closely with internal teams to streamline workflows and improve efficiency in the appeals process.

Industry Research and Compliance Monitoring

• Stay updated on healthcare regulations, payer policy changes, and legal precedents affecting technical appeals.
• Research emerging trends in Revenue Cycle Management (RCM), Accounts Receivable (AR), and payer adjudication processes to enhance appeal success rates.

Strategic Planning and Process Enhancement

• Collaborate with cross-functional teams to develop innovative solutions for technical appeals.
• Assist in crafting operational strategies to enhance the effectiveness of the appeals process.
• Identify and propose technology-driven improvements that support scalability and efficiency in appeals management.

Stakeholder Collaboration and Project Management

• Work closely with internal teams such as operations, legal, compliance and other revenue cycleteams to align appeal strategies with business objectives.
• Support leadership in data-driven decision-making, reporting key metrics, and providing insights for process improvements.
• Utilize coordination skills to manage workflow optimization projects, track milestones, and contribute to organizational process enhancement initiatives.

Required Skills & Qualifications:

• Qualifications – Graduate in BDS/MBBS/PharmD, with an MBA/MPH/MHA.
• Analytical Thinking and Research Acumen – Strong ability to analyze data, recognize trends, and identify strategic appeal opportunities.
• Innovative Problem-Solving – Think outside the box to develop creative appeal strategies and process improvements.
• AR and RCM Knowledge – Basic to advanced understanding of Accounts Receivable (AR) and Revenue Cycle Management (RCM) concepts, payer policies, and reimbursement methodologies.
• Healthcare Compliance and Legal Awareness – Familiarity with healthcare regulations, payer guidelines, and appeal adjudication frameworks is a plus.
• Project Coordination – Ability to support project management tasks, coordinate workflow optimization, and assist in strategy planning efforts.
• Data Interpretation and Reporting – Ability to extract insights from denial trends, financial reports, and operational data to drive informed decision-making.
• Collaboration and Communication – Excellent ability to communicate findings, coordinate with internal teams, and present recommendations effectively.
• Proficiency in MS Office – Strong documentation and presentation abilities, and proficient in using Excel, Word, and PowerPoint.

Why Join Us?

• Be Part of a Quintessential RnD Team – Work at the cutting edge of appeals innovation and process transformation.
• Influence Operational Strategy – Your research and recommendations will directly impact business outcomes and efficiency.
• Grow and Evolve – Gain exposure to strategic planning, project coordination, and process enhancement methodologies while developing a strong foundation in healthcare appeals.
• Innovation-Driven Culture – We value curiosity, problem-solving, and forward-thinking ideas that help us stay ahead in the industry.