Medical Appeals Specialist

Key Responsibilities: Manage healthcare arbitration and reimbursement dispute cases Work No Surprises Act (NSA) and Independent Dispute Resolution (IDR) cases Research denied and underpaid medical claims Review payer reimbursement and identify denial or payment patterns Gather supporting documentation to build arbitration and appeal cases Write detailed appeals and reimbursement arguments Submit cases through appropriate arbitration or dispute resolution channels Communicate with payers regarding reimbursement disputes Track cases through final resolution Identify opportunities to recover additional reimbursement Review case outcomes and favorable resolution trends Assist with out-of-network and other complex reimbursement issues Qualifications 2–3+ years of medical Revenue Cycle appeals, arbitration, denials, or reimbursement experience Experience personally researching and writing medical appeals Demonstrated success overturning denials or recovering additional reimbursement Strong understanding of medical claims and payer reimbursement Ability to identify denial and underpayment trends Strong research, analytical, and written communication skills Ability to independently investigate a claim and build a compelling case for reimbursement Highly Preferred: No Surprises Act (NSA) experienceIDR/IDRE or healthcare arbitration experience Out-of-network reimbursement experience Experience writing and submitting arbitration cases Surgery center or specialty medical billing experience Medical subrogation experience Payer-side arbitration or appeals experience

Ideal Candidate: We are looking for someone who enjoys digging into complex reimbursement issues and building a case for why a claim should be paid differently. You do not necessarily need direct arbitration experience if you have a strong medical appeals background. Candidates who can demonstrate a history of writing effective appeals, overturning denials, and achieving favorable reimbursement outcomes are encouraged to apply. Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Reasonable accommodation is available for qualified individuals with disabilities, upon request.