Appeals Specialist (Healthcare)

Motus Recruiting and Staffing, Inc.; Boise (ID); Remote; USD 36,000 - 39,000; Part time

Job summary

Motus Recruiting and Staffing, Inc. is seeking an Appeals Specialist I for a 5+ month contract. The role focuses on reviewing provider billing disputes, analyzing coding and reimbursement policies, and coordinating with clinical reviewers to support timely, compliant determinations.

The position is remote, with a requirement to reside in OR, WA, ID, UT, or ND and to work Pacific Time Zone hours. Responsibilities include end-to-end appeal management, eligibility validation, and collaboration with

Qualifications

• Understanding of medical terminology and anatomy.
• Experience with claims processing and healthcare operations desired.
• Coding knowledge and ability to analyze policies and guidelines.

Responsibilities

• Manage end-to-end appeal processes from intake to closure.
• Validate eligibility, timeliness, benefits, and contract provisions.
• Review claim coding and reimbursement policies to develop appeal recommendations.
• Collaborate with clinical reviewers, physicians, and coding specialists.
• Communicate decisions clearly to members, providers, and their representatives.
• Coordinate external review processes and documentation.

Skills

Healthcare terminology

Medical coding (CPT, DX, HCPCS)

Analytical thinking

Attention to detail

Verbal and written communication

Time management

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Our client, a leading healthcare organization dedicated to improving member and provider experiences, is seeking an Appeals Specialist I to support provider billing disputes and appeals processes. This role plays a critical part in ensuring accurate, timely, and compliant resolution of appeals while partnering with internal teams and external stakeholders across the organization.

The Appeals Specialist I will be responsible for reviewing claims, analyzing coding and reimbursement policies, and coordinating with clinical reviewers when needed to support appeal determinations. This is an excellent opportunity for someone who enjoys analytical work, navigating complex cases, and contributing to a high-impact healthcare operations team.

Type: Contract – 5+ months

Pay Range: $26.00 – 28.00/hr., DOE

Location: 100% Remote (Must Reside in OR, WA, ID, UT, or ND)

• Must be able to work Pacific Time Zone hours; flexibility for occasional extended hours may be required

Responsibilities of the Appeals Specialist I:

• Manage end-to-end appeal processes including intake, analysis, determination, and closure
• Validate appeal eligibility, including timeliness, member benefits, and provider contract provisions
• Review claim coding, processing history, medical policies, and reimbursement guidelines to develop appeal recommendations
• Collaborate with clinical reviewers, physicians, and coding specialists to support accurate and timely determinations
• Communicate appeal decisions clearly and professionally to members, providers, and their representatives
• Coordinate external review processes, including documentation, communication, and implementation of review outcomes
• Maintain accurate and thorough documentation of appeals within internal systems
• Track and report on appeal trends, outcomes, and opportunities for process improvement
• Provide education and support to members and providers regarding the appeals process
• Manage a defined caseload while meeting productivity, quality, and timeliness standards

Qualifications of the Appeals Specialist I:

• High school diploma or GED required
• 4+ years of experience in healthcare customer service, claims, or clinical services, or equivalent combination of education and experience
• Strong knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCS)
• Coding certification strongly preferred
• Experience with claims processing and healthcare operations (Regence experience is a plus)
• Intermediate proficiency with Microsoft Office (Word, Excel, Outlook)
• Strong analytical and problem-solving skills with high attention to detail
• Excellent verbal and written communication skills, with the ability to explain complex information clearly
• Ability to prioritize and manage multiple tasks in a fast-paced, deadline-driven environment
• Ability to maintain confidentiality and professionalism when handling sensitive information

We are unable to accommodate corp. to corp. candidates

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability or protected veteran status.