Appeals Specialist I
Portland, Oregon - Added Sep 5th, 2025
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Healthcare Appeals Specialist
Our client, a leading health care company dedicated to improving member and provider experiences, is seeking a remote Healthcare Appeals Specialist I. In this role, you will be responsible for handling Provider Billing Disputes and Appeals from start to finish. This includes intake, analysis, coordination with clinical reviewers, decision-making, communication of determinations, and documentation. You will ensure compliance with regulatory requirements, subscriber and provider contracts, and internal policies. While this position does not involve making final clinical decisions, you will collaborate closely with licensed health professionals who conduct clinical reviews.
If you are detail-oriented, thrive in a fast-paced environment, and are passionate about supporting fair and accurate claims processes, this could be a great fit!
Schedule Notes:
Contract Duration: 6-month Contract-to-Hire! Benefits Eligible
Key Responsibilities for Appeals Specialist I:
Requirements/Qualifications for Appeals Specialist I:
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.
KG/BH13394
Job ID: 13394
Our client, a leading health care company dedicated to improving member and provider experiences, is seeking a remote Healthcare Appeals Specialist I. In this role, you will be responsible for handling Provider Billing Disputes and Appeals from start to finish. This includes intake, analysis, coordination with clinical reviewers, decision-making, communication of determinations, and documentation. You will ensure compliance with regulatory requirements, subscriber and provider contracts, and internal policies. While this position does not involve making final clinical decisions, you will collaborate closely with licensed health professionals who conduct clinical reviews.
If you are detail-oriented, thrive in a fast-paced environment, and are passionate about supporting fair and accurate claims processes, this could be a great fit!
Schedule Notes:
- Ability to work weekends, holidays, or past 6:00 PM Pacific Time.
- Overtime may be required as business needs arise.
Pay Rate: $30.00 - $31.87, DOE
Location: Remote (Candidates must reside in Oregon, Washington, Idaho, or Utah)Contract Duration: 6-month Contract-to-Hire! Benefits Eligible
Key Responsibilities for Appeals Specialist I:
- Manage all activities related to appeals intake, analysis, decision-making, closure, and external review processes.
- Validate intake determinations (timeliness, member benefits, provider contract provisions).
- Review claims processing history, medical coding, contracts, and policies to formulate recommendations.
- Coordinate with coding specialists, appeal nurses, physician reviewers, and appeal panels.
- Document decisions, communicate determinations to members, providers, and their representatives.
- Provide education and assistance to members, providers, and attorneys regarding appeals.
- Track appeals in internal systems, assist with reporting, and identify trends for process improvement.
- Ensure compliance with internal policies, subscriber plan descriptions, regulatory requirements, and performance guarantees.
- Support and promote Provider or Member Appeal Policies & Procedures.
Requirements/Qualifications for Appeals Specialist I:
- High School Diploma or GED required.
- Minimum of 4 years’ experience in healthcare Customer Service, Claims, Clinical Services, or equivalent combination of education/work experience.
- Excellent verbal and written communication skills.
- Intermediate computer skills (Microsoft Word, Excel, Outlook)
- Knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCs).
- Knowledge of claims processing and clinical services operations.
- Ability to research issues, develop solutions, and implement actions.
- Strong interpersonal skills to present complex medical and reimbursement information diplomatically and persuasively.
- Ability to prioritize, adapt to shifting business needs, and maintain confidentiality.
- Coding Certification preferred.
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.
KG/BH13394
Job ID: 13394
Job ID: 13394