Appeal Support Specialist

• Process reconsiderations, redeterminations, appeals, resubmissions of previously submitted appeals, State Complaint letters, and legal submissions to the Administrative Law Judge.
• Submit requests for Coordination of Benefits or Patient Consent letters to patients.
• Ensure all submitted documentation is accurate, complete, and includes required forms.
• Submit documentation through appropriate provider portals, payer addresses, or fax numbers.
• Ensure submissions are delivered prior to payer-established deadlines.
• Draft appeal letters outlining denial details and supporting justification for overturning claims.
• Pull medical records and supporting documentation from prior hospitalizations, care episodes, or physician office records.
• Compile documentation for accounts escalated to the Managed Care Legal team following Insurance Operations review.

• High School Diploma or GED equivalent.
• Minimum of 2 years of relevant experience.
• Strong written and verbal communication skills.
• Advanced computer skills including typing, electronic medical documentation, scanning, email.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).

• Experience handling payer correspondence and documentation workflows.

hr@workway.com