Insurance Follow-Up & Appeal Specialist

Prosser Memorial Health; Prosser (WA); On-site; USD 31,000 - 44,000; Full time

Benefits offered by this job

Excellent health, dental, and vision

Retirement plan with employer contrib.

Generous paid time off

Job summary

Prosser Memorial Health is seeking an Insurance Follow-Up & Appeals Specialist to resolve unpaid, underpaid, and denied claims. You will focus on payer follow-up, denial analysis, and timely appeals to maximize reimbursement while ensuring policy compliance.

Ideal candidates have at least 1 year of revenue cycle experience, strong analytical skills, and familiarity with Medicare/Medicaid processes. Experience with Epic and rural health settings is a plus.

Qualifications

• High School Graduate or GED.
• Minimum 1 year of insurance follow-up, denial management, or appeals experience in a healthcare revenue cycle setting.
• Working knowledge of medical billing, insurance benefits, and EOB interpretation.
• Experience with Medicare, Medicaid, and commercial payers preferred.
• Strong analytical, organizational, and problem-solving skills.
• Ability to communicate professionally and effectively, both verbally and in writing.
• Preferred: CAH or rural health setting experience; familiarity with hospital billing systems (Epic); CPT/HCPCS/ ICD-10 knowledge.

Responsibilities

• Resolve unpaid, underpaid, and denied insurance claims in a timely, accurate manner.
• Perform proactive payer follow-up, denial analysis, and appeal submission.
• Ensure compliance with payer contracts, Medicare/Medicaid regulations, and organizational policies.
• Act as a subject-matter resource for complex payer issues and support revenue integrity.

Skills

Insurance follow-up

Denial management

Appeals

Medical billing knowledge

EOB interpretation

Payer communications

Analytical skills

Organizational skills

Problem-solving

Education

High School diploma or GED

Tools

Epic

Job description

FT, 80 hrs/pp, 1.0 FTE; (3 positions), varies as scheduledJob Summary:The Insurance Follow-Up & Appeals Specialist is responsible for the timely and accurate resolution of unpaid, underpaid, and denied insurance claims. This role focuses on proactive payer follow-up, denial analysis, and appeal submission to ensure appropriate reimbursement in compliance with payer contracts, Medicare/Medicaid regulations, and organizational policies. The specialist serves as a subject-matter resource for complex payer issues and supports revenue integrity through detailed documentation, trend analysis, and collaboration with internal teams.Required: High School Graduate or GED. Minimum 1 year of insurance follow-up, denial management, or appeals experience in a healthcare revenue cycle setting. Working knowledge of medical billing, insurance benefits, and EOB interpretation. Experience with Medicare, Medicaid, and commercial payers preferred. Strong analytical, organizational, and problem-solving skills. Ability to communicate professionally and effectively, both verbally and in writing.Preferred: Experience in a Critical Access Hospital (CAH) or rural health setting. Familiarity with Epic or similar hospital billing systems. Knowledge of CPT, HCPCS, ICD-10, and basic payer contract concepts. Prior experience preparing medical necessity or technical appeals.Compensation & BenefitsPay Range: $22.25-$32.25Excellent health, dental, and vision benefitsRetirement plan with employer contributionsGenerous paid time offWhy Prosser?Prosser Memorial Health is proud to be the ONLY Critical Access Hospital in Washington State with a 5-Star CMS rating and ranked among the Top 10 Recommended Hospitals in Washington.Community Highlights:Friendly, welcoming community at the heart of Washington wine country300 days of sunshine with easy access to the Yakima River and outdoor recreationJust 30 minutes from the Tri-Cities (Pasco, Kennewick, Richland) and the Tri-Cities Airport (PSC)Cost of living 18% lower than the national averageQuick 30-minute flights to Seattle, WA, or Portland, ORNational recognition:#1 Best Suburbs to Buy a House in WA (Niche)#1 Best Places to Live in WA (AreaVibes)#1 Most Secure Mid-Sized City in the U.S.Join Our Team!At Prosser Memorial Health, you’ll find more than just a job—you’ll find a community and a mission. Whether you’re an experienced professional or a new graduate, this is an opportunity to grow your career in a supportive environment, with state-of-the-art facilities and an outstanding team.