Appeals Specialist – Healthcare
Our client, a leading healthcare organization dedicated to improving member and provider experiences, is seeking an Appeals Specialist I to support provider billing disputes and appeals processes. This role plays a critical part in ensuring accurate, timely, and compliant resolution of appeals while partnering with internal teams and external stakeholders across the organization.
The Appeals Specialist I will be responsible for reviewing claims, analyzing coding and reimbursement policies, and coordinating with clinical reviewers when needed to support appeal determinations. This is an excellent opportunity for someone who enjoys analytical work, navigating complex cases, and contributing to a high-impact healthcare operations team.
Type: Contract – 5+ months
Pay Range: $26.00 – 28.00/hr., DOE
Location: 100% Remote (Must Reside in OR, WA, ID, UT, ND, or AR)
- Must be able to work Pacific Time Zone hours; flexibility for occasional extended hours may be required
Responsibilities of the Appeals Specialist I:
- Manage end-to-end appeal processes including intake, analysis, determination, and closure
- Validate appeal eligibility, including timeliness, member benefits, and provider contract provisions
- Review claim coding, processing history, medical policies, and reimbursement guidelines to develop appeal recommendations
- Collaborate with clinical reviewers, physicians, and coding specialists to support accurate and timely determinations
- Communicate appeal decisions clearly and professionally to members, providers, and their representatives
- Coordinate external review processes, including documentation, communication, and implementation of review outcomes
- Maintain accurate and thorough documentation of appeals within internal systems
- Track and report on appeal trends, outcomes, and opportunities for process improvement
- Provide education and support to members and providers regarding the appeals process
- Manage a defined caseload while meeting productivity, quality, and timeliness standards
Qualifications of the Appeals Specialist I:
- High school diploma or GED required
- 4+ years of experience in healthcare customer service, claims, or clinical services, or equivalent combination of education and experience
- Strong knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCS)
- Coding certification strongly preferred
- Experience with claims processing and healthcare operations (Regence experience is a plus)
- Intermediate proficiency with Microsoft Office (Word, Excel, Outlook)
- Strong analytical and problem-solving skills with high attention to detail
- Excellent verbal and written communication skills, with the ability to explain complex information clearly
- Ability to prioritize and manage multiple tasks in a fast-paced, deadline-driven environment
- Ability to maintain confidentiality and professionalism when handling sensitive information
**We are unable to accommodate corp. to corp. candidates**
About Motus Recruiting and Staffing, Inc:
Founded in 2006, Motus is an award-winning recruiting and staffing firm in the Pacific Northwest, specializing in professional services and technology solutions. We are a group of people who not only recognize the importance of representation, but actively fight for diversity, equity, and inclusion in the recruitment process. Our goal is to educate organizations on the importance of DEI when hiring, promoting, and supporting diverse employees. We are calling organizations to demonstrate their commitment to DEI by being intentional about who they hire.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability or protected veteran status.
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