Appeals Representative I

Appeals Representative I

Location Fort Worth, TX | Remote – MUST LIVE IN DALLAS/FORT WORTH

COMPENSATION & SCHEDULE

• $17.00 per hour

• Monday–Friday, 8:00 AM–5:00 PM

• Direct Hire, W2

ROLE IMPACT: The Appeals Representative I supports healthcare reimbursement operations by reviewing and initiating provider appeals in compliance with federal and state regulations. This role ensures appeals are accurately documented, properly entered, and processed within required timelines. Success in this position means maintaining accuracy, protecting compliance standards, and helping drive timely resolution of claims.

Key Responsibilities

• Review and analyze provider appeal documentation received via email, fax, phone, or written correspondence

• Accurately set up and initiate appeals in alignment with CMS, state regulations, and internal policy guidelines

• Ensure compliance with HIPAA and healthcare industry standards throughout the appeals process

• Utilize internal systems and Microsoft applications to document, track, and manage appeal cases

• Communicate professionally with providers and internal departments to support efficient case resolution

Minimum Qualifications

• High school diploma or equivalent required - WILL BE VERIFIED 

• 1+ year of experience in healthcare, insurance, claims processing, or customer service

• Working knowledge of medical terminology and CPT/ICD coding

Core Tools & Systems

• Microsoft Office Suite (Outlook, Word, Excel)

• Appeals and claims management systems

• Multi-system data entry platforms

• Email and document management systems

• HIPAA-compliant case documentation tools

Preferred Skills

• Experience working with Medicare, Medicaid, or commercial insurance guidelines

• Strong attention to detail in deadline-driven, fast-paced environments

• Ability to work independently in a remote setting with strong time management skills

LEGAL NOTICE

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