Medical Appeals Specialist (SCA)
About this role
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
The Medical Appeals Specialist performs reconciliation of appeals received from the Provider/MAC, as well as serving as a critical point of contact between the MAC and other internal departments within Performant. As the Medical Appeals Specialist, you will work in a fast-paced and dynamic environment and be part of a multi-location team. The successful candidate will be a team player able to collaborate with a variety of different entities to solve problems and generate solutions.
- To accurately receive, review, and forward appeal documents and requests, ensuring that all federal and state regulations, contractual compliance, and company guidelines and standards are met.
- Process all appeal documents and requests efficiently and accurately.
- Upload media to accounts and ensure uploads are successful.
- Distributes designated media to other departments as appropriate.
- Meet daily/weekly production standards.
- Provide recommendations to department management on workflow and process improvements towards efficiency, accuracy, and streamlining whenever possible.
- Complete accurately and efficiently all tasks as assigned by department management.
- Perform other incidental and related duties as required and assigned.
- High School diploma or GED required
- 5+ years in relevant office/administrative/support environment roles with progressive complexity, preferably in healthcare-related business.
- Demonstrated knowledge of healthcare audit, appeals processes, claim processing, billing, and recovery processes and practices (Medicare and Medicaid working knowledge strongly preferred).
- High level of ability in multi-tasking and prioritizing workload.
- Must have flexibility and be able to adapt to ever-changing needs and requirements.
- Intermediate MS Excel and MS Word skills.
- Strong knowledge of medical documentation.
- Able to meet or exceed deadlines.
- Ability to maintain high quality of work while meeting strict deadlines.
- Able to work efficiently, independently, and complete any/all workload as assigned by department management.
- Strong communication in both verbal and written business language skills.
- Courteous, professional, and respectful attitude.
- Responsible, dependable, conscientious, detail-oriented, and reliable.
- Work from anywhere in the US! Machinify is digital-first.
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Top Medical/Dental/Vision offerings
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FSA/HSA
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Tuition reimbursement
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Competitive salary, 401(k) with company match
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Additional health and wellness benefits and perks
- Flexible and trusting environment where you’ll feel empowered to do your best work
Company at a glance
At Machinify, we’re cutting through complexity, combining an AI-powered platform with deep domain expertise to reimagine what’s possible in healthcare, starting with the payment process.
Top Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Flexible Spending Account
- Health Savings Account
- Tuition reimbursement
- 401(k) with company match
- Health and wellness benefits
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