Clinical Operations Appeals Specialist

Position Summary:

• Serve as national subject matter expert for insurance appeals and reimbursement strategy.
• Develop evidence-based appeal packages and collaborate across teams to improve patient access.

Key Responsibilities:

• Assess complex denials and determine appeal strategies based on clinical evidence and payer policies.
• Lead continuous improvement initiatives and develop standardized appeal templates.
• Provide education and consultation to field teams and leadership on reimbursement trends.

Qualifications & Skills:

• Licensed healthcare professional preferred with 3+ years in reimbursement, appeals, or clinical documentation.
• Minimum 2 years of wound care experience and strong analytical and written communication skills.

Benefits:

• Full benefits with company-sponsored stipend, 401(k) match, and paid holidays.
• Paid vacation, sick time, volunteer time off, and employee referral bonuses.
• Car allowance, fuel reimbursement, and corporate discounts.