Appeals Specialist II - RN

Community Health Systems is one of the nation's leading healthcare providers. With healthcare delivery systems in 36 distinct markets across 14 states, CHS operates 69 affiliated hospitals with more than 10,000 beds and approximately 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, imaging centers, cancer centers, and ambulatory surgery centers.

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. 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.

Reviews and resolves pre-payment insurance denials in collaboration with follow-up teams. Coordinates with Denial Coordinators, Facility Denial Liaisons, and Managed Care Coordinators to ensure payer accountability and identify education opportunities. Provides feedback to facilities regarding denials resulting in retractions or reimbursement impacts. Monitors payer billing and coding updates and communicates changes to SSC and ancillary departments. Tracks and logs denials and appeal activity according to established documentation and reporting guidelines. Prepares and distributes reports summarizing appeal trends, project updates, and payer response activity. Recommends process improvements to enhance appeal efficiency and reduce recurring denials. Maintains up-to-date knowledge of payer policies, billing and coding practices, and reimbursement regulations. Utilizes practice management systems and maintains documentation of appeal activity in compliance with departmental standards. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards.