Clinical Appeals Strategist

Gibson Area Hospital; Gibson City (IL); On-site; USD 34,000 - 47,000; Full time

Job summary

Gibson Area Hospital is seeking a Patient Financial Services Appeals Specialist to review records, determine medical necessity, and prepare persuasive appeals to maximize reimbursement. The role collaborates with clinicians to obtain documentation and ensures compliance with payer regulations and HIPAA.

The position requires healthcare experience, knowledge of billing/coding, and strong written and verbal communication skills to support hospital, clinic, and ambulance services.

Qualifications

• High School Diploma, GED, or equivalent work experience required.
• Clinical healthcare experience is required.
• RN/LPN/Paramedic/EMT or other clinical healthcare experience preferred.
• Experience reviewing medical records and clinical documentation is preferred.
• Experience with medical appeals, medical necessity review, billing, coding or insurance guidelines preferred.
• Knowledge of CPT, ICD-10-CM, HCPCS, Medicare/Medicaid and insurance guidelines.
• Experience with EMR/EHR and billing software.
• Strong understanding of payer appeal processes.
• Excellent written communication skills.

Responsibilities

• Review patient medical records and documentation to determine medical necessity and support appeals.
• Review denied claims and identify the basis for denial.
• Research payer policies and coverage requirements.
• Prepare clear, evidence-based appeal letters to maximize reimbursement.
• Submit complete medical records and documentation with each appeal.
• Collaborate with physicians and clinical staff to obtain additional documentation.
• Submit appeals within required payer deadlines.
• Monitor appeals through final resolution and follow up with payers.

Skills

Medical terminology

Billing and coding

Insurance guidelines

Clinical documentation review

Analytical thinking

Written communication

Verbal communication

HIPAA compliance

Team collaboration

Education

High School Diploma, GED, or equivalent

Clinical healthcare experience required

RN/LPN/Paramedic/EMT experience preferred

Experience with medical appeals and payer requirements

Tools

EMR/EHR systems

Billing software

Microsoft Office / Excel

Job description

Gibson Area Hospital is seeking a Patient Financial Services Appeals Specialist to review records, determine medical necessity, and prepare persuasive appeals to maximize reimbursement. The role collaborates with clinicians to obtain documentation and ensures compliance with payer regulations and HIPAA.

The position requires healthcare experience, knowledge of billing/coding, and strong written and verbal communication skills to support hospital, clinic, and ambulance services.