Clinical Appeals Specialist
We have an exciting opportunity for you to join our team as a Clinical Appeals Specialist. In this position, you will play a vital role in delivering our “Service First” value proposition to our patients, therapists, and physician stakeholders. As a member of our team, you will have an opportunity for personal and professional growth and career advancement as we build on our consecutive years of significant growth. In addition to base pay, our employees are eligible for bonuses based on personal and company performance.
Summary
The Clinical Appeals Specialist partners with the sales team, therapists, and Insurance Liaison to improve insurance approval rates for Complex Rehab Technology (CRT) equipment. This role investigates denials, identifies documentation gaps, collaborates with therapists to strengthen medical necessity support, and manages appeals through resolution. The position also analyzes denial trends and helps improve documentation and reimbursement processes to increase first-pass approvals.
Main responsibilities
Manage insurance appeals from denial through final resolution.
Review denials to identify documentation deficiencies and develop corrective action plans.
Obtain, organize, and submit supporting documentation.
Monitor appeal deadlines and maintain accurate appeal records.
Coordinate communication among therapists, sales representatives, facilities, and internal
teams.Work directly with therapists to clarify documentation and strengthen medical necessity
justification.Serve as a resource for documentation and reimbursement questions.
Collaborate with sales representatives and healthcare facilities to obtain necessary information.
Travel as needed to facilitate documentation collection and appeal support.
Analyze denial trends and payer requirements to identify improvement opportunities.
Develop best practices, educational resources, and documentation guidelines.
Recommend process improvements that reduce denials and improve reimbursement
outcomes.Support ongoing initiatives to increase efficiency and approval rates.
Qualifications
Experience in a clinical/health care related field.
Clean driving record with the ability to travel extensively throughout the assigned territory.
Ability to work independently while exercising sound clinical judgment and professional
decision-making skills.
Strong interpersonal, communication, and problem-solving abilities when working with
patients, caregivers, therapists, physicians, and referral partners.
Effective ability to prioritize competing responsibilities while maintaining attention to detail
and meeting deadlines.
Education
Associates, Bachelors, Masters, and/or Doctorates in Physical or Occupational Therapy, or a degree in a related field.
Working conditions
Variable work hours - (Hours may exceed 40 hours per week)
70% travel, 30% home office
Apply here
NPL Home Medical is an Equal Opportunity Employer. NPL Home Medical does not discriminate against any person on the basis of gender, race, color, national origin, religion, disability, age, veteran status, gender identity or sexual orientation in admission, treatment, or participation in its programs, services and activities, or in employment, or on the basis of gender in its health programs and activities.