Appeals Specialist & Patient Advocate (Remote)

Quadax, Inc.; Middleburg Heights (OH); On-site; USD 45,000 - 65,000; Full time

Job summary

Quadax, Inc. seeks a denial management specialist to respond to insurance denials by preparing appeals and required documentation, and submitting them to payers within filing deadlines.

The role includes reviewing case history, gathering records, and coordinating external reviews to maximize reimbursement for patients. The position begins with on-site training for 3 months at Middleburg Heights, OH or Milan, OH, after which the role transitions to remote work.

Qualifications

• Four years of health insurance billing experience.
• Knowledge of managed care payer structures and rules.
• Ability to meet deadlines and maintain confidentiality.
• Detail oriented with strong written and verbal skills.
• Proficient with Excel and Word.

Responsibilities

• Review denials and EOBs for appeal filing information; gather missing information.
• Review case history, payer history, and state requirements to determine appeal strategy.
• Obtain patient and/or physician consent and medical records when required.
• Gather and fill out all special appeal or review forms.
• Create appeal letters, attach the materials, and mail them.
• Coordinate phone hearings with the insurer, patient, and physician.
• Comply with all appeal processes, SOPs, and documentation.
• Meet deadlines by completing tasks on the worklist and escalating when needed.
• Report requirements and denial trends to leadership.
• Participate in team meetings and share case details.
• Act as backup for incoming calls as needed.
• May undertake special projects as assigned.
• Maintain productivity and quality standards.

Skills

Denials management

Appeal letters

Insurance billing

Communication skills

Microsoft Excel

Microsoft Word

Attention to detail

Time management

Education

High School diploma/GED

Tools

Microsoft Excel

Microsoft Word

Job description

Quadax, Inc. seeks a denial management specialist to respond to insurance denials by preparing appeals and required documentation, and submitting them to payers within filing deadlines.

The role includes reviewing case history, gathering records, and coordinating external reviews to maximize reimbursement for patients. The position begins with on-site training for 3 months at Middleburg Heights, OH or Milan, OH, after which the role transitions to remote work.