Claims/Appeals Specalist

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Located in Corpus Christi, TX

We are seeking a detailed-oriented Claims/Appeals Specialist to join our clients team in their billing department. This role is responsible for reviewing, correcting, and appealing denied or underpaid insurance claims, with strong focus on Medicaid and Medicare. The ideal candidate will have a solid understanding of insurance guidelines, billing processes, and payer requirements. 

Key Responsiblilties: 

Review denied or rejected claims and determine appropriate action

• Prepare and submit appeals to insurance companies, including Medicaid and Medicare
• Analyze Explanation of Benefits and remittance advice
• Research and resolve claim discrepancies and underpayments
• Communicate with insurance carriers to follow up on claims status
• Work closely with billing and coding teams to ensure accurate claim submission
• Maintain detailed documentation of all claim activity and appeals
• Stay up to date on payer policies, especially Medicaid and Medicare guidelines

Qualifications: 

• Experience in medical billing, claims and appeals
• Strong knowledge of Medicaid and Medicare policies and procedures (required)
• Experience working with insurance denials and appeals
• Familiar with EMR systems (eClinical Works)
• Strong attention to detail and problem-solving skills
• Excellent communication and organizational skills
• Knowledge of CPT, ICD-10, and HCPCS coding

Competitive pay based on experience

Benefits offered when hired permanently by our client. 

Schedule: Monday - Friday 8am-5pm

 

 

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