Appeals Specialist

Purpose of the Job:

The Appeals Specialist manages invoice deductions and appeal submissions to support compliance with client and insurance company billing guidelines. The role reviews deduction activity, coordinates with attorneys and billing staff, tracks appeal outcomes, and supports workflow improvement and training.

Key Responsibilities:

1. Deduction Review & Distribution
• Review invoice deductions and distribute deduction reports to attorneys for reduced entries in a timely manner.
• Ensure deduction activity is processed accurately and in compliance with client and/or insurance company billing guidelines.
2. Appeals Processing & Compliance
• Track and process bill deductions and subsequent appeals across applicable client matters.
• Monitor appeal responses and deadlines to help ensure the firm remains in compliance with billing guidelines.
3. Stakeholder Communication & Coordination
• Communicate regularly with the billing team, attorneys, internal departments, external clients, and management regarding deduction and appeal matters.
• Determine priorities, calendar deadlines, and coordinate follow-up activities related to deduction reviews and appeal submissions.
4. Process Improvement & Training Support
• Regularly review the appeals process to identify areas for improvement in workflow, timeliness, and accuracy.
• Update training and workflow documentation as needed based on feedback, results, and performance metrics.

Required Qualifications:

1. Education
• High school diploma or equivalent required.
• Additional education or training in billing, finance, legal administration, or a related field preferred.
2. Experience
• Minimum of three years of e-billing and appeals experience in an insurance defense law firm setting strongly preferred.
• Experience with client billing guidelines, insurance billing requirements, deduction terminology, and appeal submissions strongly preferred.
3. Skills
• Aderant experience is required; BillBlast experience is strongly preferred; working knowledge of associated e-billing platforms is required.
• Strong written and verbal customer service, organizational, and time-management skills with the ability to meet deadlines and manage multiple inquiries.
• Strong analytical, problem-solving, research, and investigative skills.
• Ability to communicate effectively with attorneys, billing staff, clients, internal departments, and management.

Physical Requirements:

1. Ability to work at a computer for extended periods and use standard office technology and e-billing platforms.
2. Ability to sit, stand, and communicate effectively in person and through phone, video, and electronic systems.

Performance Measures:

1. Goals
• Timely review and distribution of deduction reports.
• Accuracy and compliance of appeals submissions with client and insurance company billing guidelines.
• Effective tracking of responses, deadlines, and follow-up activity.
2. Competencies
• Attention to detail and accuracy.
• Analytical judgment and problem-solving.
• Communication and service orientation.
• Organization and deadline management.

Working Conditions:

1. Professional office environment within a law firm or similar professional services setting.
2. Fast-paced workload with frequent deadlines, multiple inquiries, and regular coordination with attorneys, billing personnel, clients, and internal departments.