Appeals Specialist
Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.
About This Opportunity:
As an Appeals Specialist, you’ll manage clinical appeals by reviewing claims, drafting appeal letters, and collaborating with teams to resolve payer denials. You will ensure regulatory compliance, maintain accurate records, and support efforts to prevent future denials.
Things You’ll Do Here:
- Review medical records and claims to assess the need for appeals.
- Maintain current knowledge of regulatory guidelines and medical necessity criteria.
- Collaborate with legal counsel on complex or escalated appeals.
- Document all appeal actions and outcomes in the designated system.
- Track, manage, and report on the status of all pending and completed appeals.
- Assist in developing and refining policies and procedures for the appeals process.
- Oversee all aspects of clinical appeals related to payer denials.
- Draft appeal letters that present compelling clinical arguments to support overturning denials.
- Stay informed on updates to regulations, medical coding, and billing protocols.
- Maintain accurate and detailed records of appeals and outcomes.
- Ensure compliance with state and federal regulations governing medical appeals.
- Partner with the healthcare team to implement strategies for denial prevention and reduction.
Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.
What You’ll Bring to the Team:
- 2+ years of experience in appeals, denials management, or a related field.
- 2+ years of experience in medical records review, claims processing, or healthcare operations.
- Proficient in medical coding standards, including ICD-10, CPT, HCPCS, and revenue codes.
- Strong attention to detail with a commitment to accuracy in data entry and documentation.
- Solid understanding of CMS guidelines and payer-specific requirements.
- Exceptional organizational and time management skills.
- Ability to effectively multitask and prioritize work in a dynamic, fast-paced environment.
- Excellent written and verbal communication skills.
A plus if you have
- Auditing, claims, review and/or billing experience with a healthcare organization.
- CPC and/or CIC certifications
- Encoder Pro and/or Find-A-Code software experience.
Where You’ll Work: This is a fully remote position, and we’ll provide all the necessary equipment!
Work Environment: You’ll need a quiet workspace that is free from distractions.
Technology: Reliable internet connection—if you can use streaming services, you’re good to go!
Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.
Why You'll Love Working Here
Valenz is proud to be recognized by Inc. 5000 as one of America’s fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. With this commitment, you’ll find an engaged culture – one that stands strong, vigorous, and healthy in all we do.
Benefits
- Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
- Spending account options: HSA, FSA, and DCFSA
- 401K with company match and immediate vesting
- Flexible working environment
- Generous Paid Time Off to include vacation, sick leave, and paid holidays
- Employee Assistance Program that includes professional counseling, referrals, and additional services
- Paid maternity and paternity leave
- Pet insurance
- Employee discounts on phone plans, car rentals and computers
- Community giveback opportunities, including paid time off for philanthropic endeavors
At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.