Appeals Specialist Appeals RnD

About the Role

As an Appeals Specialist in the Appeals RnD team at PrimEra Medical Technologies, you will play a pivotal role in analyzing patient accounts, identifying opportunities for appeals, and researching industry updates, legal aspects, and strategic enhancements in the appeals process.

This role is at the intersection of operations, process innovation, and healthcare regulatory strategy, making it a unique opportunity for professionals who enjoy diving deep into analytical solutions and influencing operational excellence.

Key Responsibilities

• Conduct in-depth analysis of patient accounts to determine eligibility for technical appeals.
• Identify potential appeal opportunities based on payer guidelines, claim denials, and compliance regulations.
• Develop and implement appeal strategies to maximize revenue recovery and ensure compliance with regulatory policies.
• Work closely with internal teams to streamline workflows and improve efficiency in the appeals process.
• Stay updated on healthcare regulations, payer policy changes, and legal precedents affecting technical appeals.
• Research emerging trends in Revenue Cycle Management (RCM), Accounts Receivable (AR), and payer adjudication processes to enhance appeal success rates.

Skills & Qualifications

• Graduate in BDS/MBBS/PharmD, with an MBA/MPH/MHA.
• Strong analytical thinking and research acumen to analyze data, recognize trends, and identify strategic appeal opportunities.
• Innovative problem-solving skills to develop creative appeal strategies and process improvements.
• Basic to advanced understanding of Accounts Receivable (AR) and Revenue Cycle Management (RCM) concepts, payer policies, and reimbursement methodologies.
• Familiarity with healthcare regulations, payer guidelines, and appeal adjudication frameworks is a plus.
• Ability to support project management tasks, coordinate workflow optimization, and assist in strategy planning efforts.
• Ability to extract insights from denial trends, financial reports, and operational data to drive informed decision-making.
• Excellent ability to communicate findings, coordinate with internal teams, and present recommendations effectively.
• Proficient in using MS Office, with strong documentation and presentation abilities.

What You'll Learn

In this role, you will gain exposure to strategic planning, project coordination, and process enhancement methodologies while developing a strong foundation in healthcare appeals.

You will have the opportunity to work at the cutting edge of appeals innovation and process transformation, influencing operational strategy and driving business outcomes and efficiency.

Resume Tip

When applying for this role, be sure to tailor your resume to highlight your analytical thinking and research acumen, as well as your experience with Accounts Receivable (AR) and Revenue Cycle Management (RCM) concepts.

Use specific examples to demonstrate your ability to analyze data, recognize trends, and identify strategic appeal opportunities, and highlight any relevant certifications or training in healthcare regulations and compliance.