Medical Appeals Specialist (SCA) in New York at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Medical Appeals Specialist (SCA) based in United States.

This role supports the accurate and timely processing of medical appeals within a fast-paced healthcare operations environment.
You will review, reconcile, and route appeal documentation while ensuring compliance with applicable regulations, contractual requirements, and internal standards.
The position serves as an important connection point between external providers, internal teams, and operational stakeholders.
You will handle a varied workload requiring strong organization, attention to detail, and the ability to prioritize competing deadlines.
The role is well suited to someone with healthcare claims, appeals, audit, billing, or recovery experience who enjoys solving problems collaboratively.
You will also have opportunities to identify workflow improvements that strengthen efficiency, accuracy, and service quality.
Success in this position requires reliability, adaptability, strong communication, and the ability to work independently while contributing to a distributed team.

• Receive, review, reconcile, and forward medical appeal documents and requests accurately and efficiently.
• Ensure all appeal activities comply with applicable federal and state regulations, contractual requirements, and established organizational guidelines.
• Process appeal documentation within required service levels while maintaining a consistently high standard of accuracy and quality.
• Upload media and supporting documentation to appropriate accounts, verify successful uploads, and resolve issues when necessary.
• Distribute designated media and appeal-related information to the appropriate internal departments.
• Serve as a key point of contact between providers, external stakeholders, and internal teams involved in the appeals process.
• Meet established daily and weekly production standards while maintaining accuracy and attention to detail.
• Identify workflow inefficiencies and recommend process improvements that can increase operational efficiency, accuracy, and consistency.
• Prioritize and manage multiple assignments effectively in a changing operational environment.
• Complete additional administrative, operational, and appeals-related responsibilities as assigned by department leadership.
• Collaborate with colleagues across locations and functions to resolve issues, address discrepancies, and develop practical solutions.

• High school diploma or GED required.
• At least 5 years of relevant office, administrative, healthcare, or support experience, ideally with progressively complex responsibilities.
• Demonstrated knowledge of healthcare audits, medical appeals, claims processing, billing, recovery processes, and related operational practices.
• Working knowledge of Medicare and Medicaid processes is strongly preferred.
• Strong understanding of medical documentation and the ability to accurately review and handle sensitive information.
• Intermediate proficiency with Microsoft Excel and Microsoft Word, including the ability to organize and manage operational information.
• Excellent multitasking and prioritization skills, with the ability to manage competing deadlines and changing requirements.
• Strong attention to detail and a demonstrated ability to maintain high-quality work while meeting strict production expectations.
• Ability to work independently, take ownership of assigned workloads, and complete tasks efficiently with appropriate judgment.
• Strong written and verbal business communication skills.
• Professional, courteous, dependable, conscientious, and reliable approach to work.
• Adaptability and willingness to adjust quickly to evolving business needs, processes, and priorities.
• Strong problem-solving skills and a collaborative mindset, with the ability to work effectively with different teams and stakeholders.

• $21.00 per hour base pay.
• Fully remote work from anywhere in the United States.
• Medical, dental, and vision insurance options.
• Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
• 401(k) retirement plan with company match.
• Tuition reimbursement opportunities.
• Additional health and wellness benefits and employee perks.
• Flexible, trusting work environment designed to empower employees to perform at their best.
• Opportunity to contribute to healthcare operations that focus on improving efficiency, transparency, and financial outcomes.