Appeals Specialist

World Travel & Connect; Georgia; On-site; USD 45,000 - 65,000; Full time

Job summary

Medical Data Systems Inc. is looking for a detail-oriented Insurance Specialist to join their billing team. The role involves managing insurance claims, navigating various systems, and ensuring confidentiality in compliance with HIPAA regulations.

The ideal candidate will have 3-5 years of experience in a healthcare environment, proficiency in insurance processes, and strong communication skills. This is a full-time position based in Georgia.

Qualifications

• 3-5 years of experience in a healthcare setting such as a hospital business office or health insurance organization.
• Proficient with HCPCS/CPT/ICD-10 coding basics and claim submission processes.
• Experience with medical billing and collection practices.

Responsibilities

• Perform insurance follow-up activities, including claim submission and filing appeals.
• Process detailed account information accurately within performance guidelines.
• Maintain confidentiality and adhere to HIPAA regulations.

Skills

Strong communication skills

Attention to detail

Self-motivation

Proficient knowledge of insurance processes

Ability to type at least 55 words per minute

Education

High School Diploma or GED

Some college preferred

Job description

Medical Data Systems Inc. is seeking a detail-oriented and motivated Insurance Specialist to join our insurance support and billing team. The ideal candidate will demonstrate professionalism, independence, and a strong understanding of insurance processes while thriving in a fast-paced environment.

Key Responsibilities

• Perform insurance follow-up activities, including claim submission, claim status inquiries, and filing appeals for denied claims
• Process a high volume of detailed account information accurately and within established performance guidelines
• Navigate multiple systems to obtain insurance, contact, and attorney information as needed
• Support the prioritization of collections efforts by accurately updating account data and identifying next steps
• Maintain the highest level of confidentiality and adhere to all HIPAA regulations
• Apply hospital billing knowledge to carry out assigned duties efficiently

Essential Duties

• Complete insurance-related tasks such as correcting and resubmitting claims, filing appeals, and contacting insurance companies, attorneys, or patients regarding outstanding balances
• Work assigned facility-specific queues, ensuring all accounts are updated with correct and complete information
• Participate in special projects or assignments as directed
• Assist colleagues and management by providing information or support related to insurance processes when needed

Qualifications

• 3-5 years of experience in a healthcare setting such as a hospital business office, surgery center, physician practice, or health insurance organization
• Strong communication skills, attention to detail, and self-motivation
• Proficient knowledge of insurance processes, including claim submission, claim denials, HCPCS/CPT/ICD-10 coding basics, and claim status inquiries
• Familiarity with Medicare/Medicaid, Commercial, Auto, Workers’ Compensation, Liability, Crime Victims, and State/Federal Insurance Programs
• Experience with medical billing and collection practices, business office procedures, and multi‑system computer navigation
• Ability to type at least 55 words per minute
• High School Diploma or GED required; some college preferred

Position Details

• Employment Type: Full‑Time