Medical Appeals Specialist – Denials & Reimbursement

Gibson-Area-Hospital-; Gibson City (IL); On-site; USD 50,000 - 80,000; Full time

Job summary

Gibson Area Hospital & Health Services in Illinois is seeking a Patient Financial Services Appeals Specialist. The role reviews patient records and clinical documentation to determine medical necessity, prepares formal appeals, and submits supporting materials to maximize reimbursement while ensuring payer compliance.

You will collaborate with physicians, nurses, and billing staff to gather documentation, review denial reasons, track appeals through final resolution, and maintain accurate

Qualifications

• High School Diploma or GED required.
• Clinical healthcare experience required.
• RN/LPN/Paramedic/EMT or other clinical healthcare experience preferred.
• Experience with medical appeals, medical necessity review, billing, coding, or insurance guidelines preferred.
• Familiar with HIPAA and compliance in charging and billing.

Responsibilities

• Review patient records and documentation to determine medical necessity and support appeals.
• Review denied claims and identify clinical or administrative 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.
• Track appeals through final resolution and communicate trends for improvement.

Skills

Clinical terminology

Medical billing & coding

Payer guidelines

Communication

Analytical thinking

Education

High School Diploma or GED

Clinical healthcare experience

RN/LPN/Paramedic/EMT preferred

Tools

EMR/EHR systems

Billing software

Microsoft Excel

Job description

Gibson Area Hospital & Health Services in Illinois is seeking a Patient Financial Services Appeals Specialist. The role reviews patient records and clinical documentation to determine medical necessity, prepares formal appeals, and submits supporting materials to maximize reimbursement while ensuring payer compliance.

You will collaborate with physicians, nurses, and billing staff to gather documentation, review denial reasons, track appeals through final resolution, and maintain accurate