Appeals Specialist Team Lead

Job description

Description Job purpose: The Appeals Lead provides advanced oversight of insurance denial and underpayment management, serving as both a senior technical expert and operational leader within Revenue Cycle Management. This role is responsible for managing complex appeals, monitoring denial and appeal performance trends, training and mentoring Appeals Specialists, and ensuring consistent execution of best practices. The Appeals Lead plays a critical role in driving improved reimbursement outcomes, reducing preventable denials, and promoting accountability through KPI monitoring and staff development. Duties and responsibilities: Appeals and Denial Management: Denial Trend Analysis and KPI Oversight - Reviews unpaid, underpaid, and denied claims to determine appeal viability, with a focus on high-dollar, high-risk, and complex cases. - Prepares, reviews, and submits written appeals, grievances, and reconsideration requests with complete and accurate supporting documentation. - Provides quality review and guidance on appeal letters prepared by Appeals Specialists to ensure accuracy, compliance, and effectiveness. - Researches payer contracts, policies, medical necessity criteria, and r...