RCM Appeals Specialist

About the Role

We are seeking a detail-oriented RCM Appeals Specialist to support denial appeal operations for hospitals, ambulance providers, and physician groups. You will retrieve documentation, follow up with insurance payers, maintain accurate case records, and ensure compliance with client SLAs and internal procedures.

Key Responsibilities

• Retrieve supporting documentation from EMR/EHR systems (e.g., Epic, Paragon).

• Make outbound follow-up calls to insurance payers regarding appeal status.

• Log call activity and case updates in CSS Impact.

• Monitor case progress and provide timely status updates.

• Organize case documentation while maintaining compliance and confidentiality.

• Follow internal SOPs and client-specific requirements.

Requirements

• Experience in US Healthcare RCM, Medical Billing, Denials, or Appeals.

• Familiarity with EMR/EHR systems.

• Strong communication and phone skills.

• Ability to work in a compliance- and SLA-driven environment.

• Strong attention to detail and organizational skills.

Preferred Qualifications

• Experience with Epic, Paragon, or similar EMR/EHR systems.

• Familiarity with CSS Impact or similar case management software.

• Knowledge of HIPAA and healthcare compliance.

What You'll Need to Succeed

• Excellent attention to detail and accuracy.

• Strong time management and organizational skills.

• Professional communication skills.

• Ability to learn new processes and work collaboratively.