Appeal Specialist II - RN/PT/OT/SLP

Benefits Comprehensive Health Coverage – Medical, dental, and vision plans to keep you and your family healthy. Future Security: 401(k) with matching Student Loan Support – Up to $10,000 repayment assistance, because we invest in your future. Educational Tuition Assistance Competitive Pay & Full Benefits – A salary and package designed to reward your expertise and dedication. Paid Time Off Job Summary The Appeal Specialist II reviews, analyzes, and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. This role logs and reviews denials for trend reporting, provides feedback to facilities, and communicates payer updates to relevant stakeholders. The Appeal Specialist II collaborates with internal teams to ensure timely and thorough appeal resolution and supports initiatives that improve denial prevention and recovery processes. Essential Functions Files medical necessity and level of care appeals using MCG, InterQual, CMS, and other guidelines as needed. Files other clinical appeals on in scope denial types including, but not limited to denials surrounding readmissions, experimental and investigational determinations, and coverage based determinations. Monitors clinical appeal processes for issues and trends and provides guidance and feedback to related departments as needed. Tracks and manages clinical denials using current tools (manuals, training programs). Identifies patterns and trends in denials; communicates to appropriate persons. M