Appeals Specialist


LOCATION: This position is located in Newport, KY, two blocks from Newport on the Levee

HOURS: Monday – Friday, 7:30AM – 4:00PM


  • High School Diploma
  • 2-5 years of medical billing, especially in appeals and follow up.
  • Laboratory and/or worker compensation experience a plus
  • Billing or Coding Certification a plus


The Appeals Specialist assesses and completes appropriate documentation for tracking/trending data. Conducts all pertinent research in order to evaluate, respond and close incoming Provider Disputes and/or Member Appeals accurately, timely, and in accordance with all established regulatory guidelines inclusive of appropriate review of claims and prior claim payment history. Interfaces with internal departments and external resources and organizations. Prepares and assists with reports for unit. Maintains confidentiality as required.

  • Reviews all claim line items denials and analyzes medical information from records against billed procedures.
  • Performs a detailed review of the medical record to verify each line is coded with the appropriate diagnosis, procedure, and revenue code and that the ICD-9 / ICD-10 diagnosis and procedure codes were coded and sequenced correctly to achieve the appropriate MS-DRG, AP-DRG, or APR-DRG.
  • Responsible for resolving any and all pre-bill edits, denials, etc. for assigned accounts.
  • Assures that payer reimbursement is appropriate and accurate with contract/policy.
  • Makes corrections and rebills as appropriate to maximize billing and reimbursement processing
  • Follows up on all appeals and no response accounts.
  • Establishes excellent relationships with payers, clients, and internal staff.
  • Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes.
  • Assists billing staff including but not limited to Appeals, Follow-up, Payment posting, e-commerce etc.


  • Regular and prompt attendance
  • Exceptional accuracy and attention to detail
  • Effective verbal and written communication
  • Excellent phone etiquette
  • Good knowledge of all aspects of the Revenue Cycle
  • Ability and experience with Microsoft Outlook, Word, and Excel
  • Ability to work well in a team environment
  • Follow all department and company policies and procedures