Revenue Cycle Specialist | Appeal Writer

Revenue Cycle Specialist
Appeal Writer | Professional Billing Denials

The primary purpose of the RCS Appeal Writer is to analyze, draft, and submit high-quality appeal letters to address denied or underpaid Professional Billing (PB) claims. This position requires comprehensive knowledge of payer requirements, denial codes, and clinical documentation to effectively challenge denials and provide support to the Accounts Receivable (AR) Follow-Up team. The Appeal Writer must possess a thorough understanding of PB denial reasons, payer policies, and appeal procedures in order to develop detailed and effective appeal letters that enhance claim reimbursement outcomes. The Appeal Writer works collaboratively with billing specialists, clinical staff, and payer representatives to ensure the timely and accurate resolution of outstanding claims.

FLSA Status: Non-exempt

Hiring Remotely in: AL, GA, SC, NC, FL, TX, TN, KY, VA

Responsibilities

• Analyze denied and unpaid claims to accurately identify professional billing (PB) denial reasons and payer-specific issues.
• Compose clear, concise, and persuasive appeal letters addressing complex professional billing (PB) denials to resolve outstanding claims.
• Utilize comprehensive knowledge of professional billing (PB) denial codes, documentation requirements, and medical billing guidelines in appeals.
• Collaborate closely with billing specialists, clinical teams, and payers to gather and validate supporting documents for appeal submissions.
• Track and document all appeal activities and outcomes within AR management systems.
• Monitor appeal progress and conduct timely follow-up communications with payers to expedite claim resolution.
• Identify trends in PB denial patterns to suggest improvements in billing and documentation processes.
• Professionally communicate with payers, clients, and internal teams via phone, email, and electronic portals.
• Performs other related duties as assigned.

Required Knowledge & Skills

• Extensive experience and expertise in Professional Billing (PB) denials, including detailed knowledge of common denial types and resolutions.
• Strong understanding of payer-specific appeal requirements, denial codes, coding/billing regulations (CPT, ICD), and medical documentation standards.
• Proven ability to craft persuasive, error-free and payer-compliant appeal letters that effectively address denial reasons.
• Excellent written communication skills with a keen eye for detail.
• Familiarity with electronic medical records (EMR) and medical billing software.
• Ability to prioritize and manage multiple appeals while meeting deadlines.
• Ability to identify patterns, inconsistencies, and opportunities for process improvement.

Job Requirements & Preferences

• Minimum Education: High school diploma or GED required.
• Minimum Years of Experience: 4+ years experience with PB denials and appeal letter writing required; prior experience handling a high volume of professional claims is preferred
• Software/Systems Experience: Epic or related system experience required. Must also possess experience working with MS Office and Adobe Acrobat programs with an emphasis on word processing functions
• Additional Certifications: Certification in Medical Billing, Coding, or Healthcare Revenue Cycle Management preferred

This job description is not intended to be an exhaustive list of all duties. Employee may perform other related duties as assigned.

VBOA provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, VBOA complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.

VBOA expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status.