Appeals Specialist

{
  "content_hash": "fafbed764c011a8f37954b27b457e5870fb412613f2d586bbe34e856165e60ee",
  "source_hash": "0563730ef0287d5190027fb9000a856282b0366cbf1ac4ab3096ceae324064cb",
  "last_changed_at": "2026-05-30T06:01:41.990Z",
  "active_status": "active"
}

{
  "language": "en",
  "location": {
    "raw": "Gardena, California, 90248, United States",
    "city": "Gardena",
    "region": null,
    "country": "United States",
    "is_remote": false,
    "confidence": 0.95
  },
  "salary_max": null,
  "salary_min": null,
  "inferred_at": "2026-06-06T10:31:21.011Z",
  "launch_scope": {
    "reason": "bamboohr_production_catalog",
    "included": true,
    "location": {
      "raw": "Gardena, California, 90248, United States",
      "city": "Gardena",
      "region": null,
      "country": "United States",
      "is_remote": false,
      "confidence": 0.95
    },
    "countries": [
      "United States"
    ]
  },
  "remote_policy": null,
  "salary_period": null,
  "workplace_type": null,
  "salary_currency": null
}

{}

{
  "list_job": {
    "id": "40",
    "isRemote": null,
    "location": {
      "city": "Gardena",
      "state": "California"
    },
    "atsLocation": {
      "city": null,
      "state": null,
      "country": null,
      "province": null
    },
    "departmentId": "18441",
    "locationType": "0",
    "jobOpeningName": "Appeals Specialist",
    "departmentLabel": "Insurance Recovery",
    "employmentStatusLabel": "Full-Time"
  },
  "detail_errors": [],
  "detail_job_opening": {
    "location": {
      "city": "Gardena",
      "state": "California",
      "postalCode": "90248",
      "addressCountry": "United States"
    },
    "datePosted": "2021-09-10",
    "atsLocation": {
      "city": null,
      "state": null,
      "country": null,
      "countryId": null
    },
    "description": "<p><span style=\"font-size: 15px; font-weight: bold;\">APPEALS SPECIALIST </span></p>\r\n<p><br></p>\r\n<p><span style=\"font-size: 15px;\"><span>Do you like challeng</span><span>ing payers</span><span>?</span><span>  </span><span>That f</span><span>eeling </span><span>of</span><span> satisfaction </span><span>when your appeal is overturned?</span><span> </span><span>  Then, this position may be right for you!  </span></span><span style=\"font-size: 15px;\"> </span></p>\r\n<p><br></p>\r\n<p><span style=\"font-size: 15px;\"><span>CAF is in search of an experienced Appeals Specialist who is well versed in challenging </span><span>insurance denials, </span><span>utilizing payer guidelines and applicable state laws.  </span><span>The ideal candidate must have the ability to multitask, meet goals and work well individually and </span><span>with </span><span>others on special projects and ind</span><span>ividual </span><span>workloads.    </span></span><span style=\"font-size: 15px;\"> </span></p>\r\n<p><br></p>\r\n<p><span style=\"font-size: 15px;\"><span>RESPONSIBILITIES:</span></span><span style=\"font-size: 15px;\"> </span></p>\r\n<ul>\r\n<li><span style=\"font-size: 15px;\"><span>Developing well-supported appeal arguments, where an appeal is </span><span>warranted.</span></span></li>\r\n<li><span style=\"font-size: 15px;\"><span>Work with and contact insurance companies to resubmit denied</span><span>/</span><span>underpaid claims that are inaccurately processed and continually upheld.</span></span><span style=\"font-size: 15px;\"> </span></li>\r\n</ul>\r\n<ul>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>Notate system of record thoroughly and accurately.</span></span><span style=\"color: #222222; font-size: 15px;\"> </span></li>\r\n<li><span style=\"font-size: 15px;\"><span>Filing complaints and grievances through the DMHC, DOI, DOL, CMS and Medicaid systems to resolve unfair payment practices and trends.  </span></span><span style=\"font-size: 15px;\"> </span></li>\r\n<li><span style=\"font-size: 15px;\"><span>Filing complaints to the jurisdiction of HMO, PPO, ERISA, </span><span>Medicare</span><span> and Medicaid agencies when claims are denied in error. </span></span><span style=\"font-size: 15px;\"> </span></li>\r\n<li><span style=\"font-size: 15px;\"><span>Perform follow up on any outstanding claims,</span><span> manage correspondence and requests and research denials and zero payments.</span></span><span style=\"font-size: 15px;\"> </span></li>\r\n</ul>\r\n<p><br></p>\r\n<p><span style=\"font-size: 15px;\"><span>MINIMUM REQUIREMENTS/QUALIFICATIONS:</span></span><span style=\"font-size: 15px;\"> </span></p>\r\n<ul>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>3 to 5+</span><span> </span><span>years</span><span> of recent experience writing insurance appeals and pursuing payers for collection on behalf of hospitals (facility charges).</span></span><span style=\"color: #222222; font-size: 15px;\"> </span></li>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>Understanding of medical terminology, bill review, general coding, and appeals resolution.</span></span><span style=\"color: #222222; font-size: 15px;\"> </span></li>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>Ability to read, analyze, and interpret hospital medical bills, records, statutes, contracts, and other relevant documents.</span></span><span style=\"color: #222222; font-size: 15px;\"> </span></li>\r\n<li><span style=\"font-size: 15px;\"><span>Knowledge of medical necessity, time filing, UCR and contract denials.</span></span><span style=\"font-size: 15px;\"> </span></li>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>High comfort level with Excel</span></span><span style=\"color: #222222; font-size: 15px;\"> </span></li>\r\n</ul>\r\n<ul>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>A focused, organized, and detail-oriented approach to work.</span></span><span style=\"color: #222222; font-size: 15px;\"> </span></li>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>50+ wpm</span></span><span style=\"color: #222222; font-size: 15px;\"> </span></li>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>Knowledge of </span></span><span style=\"color: #202124; font-size: 15px;\"><span>Milliman/InterQual guidelines</span></span><span style=\"color: #202124; font-size: 15px;\"> </span></li>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>Excellent oral and written communication skills.</span></span><span style=\"color: #222222; font-size: 15px;\"> </span></li>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>Ability to pass a thorough background check and drug screen. </span></span><span style=\"color: #222222; font-size: 15px;\"> </span></li>\r\n</ul>\r\n<ul>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>Ability to perform critical work under deadlines. </span></span><span style=\"color: #222222; font-size: 15px;\"> </span></li>\r\n<li><span style=\"color: #222222; font-size: 15px;\"><span>Ability to work in a changing environment and handle multiple </span><span>tasks</span></span><span style=\"color: #222222; font-size: 15px;\"> </span></li>\r\n</ul>\r\n<p><br></p>\r\n<p><span style=\"font-size: 15px;\"><span>PREFERRED (NOT REQUIRED):</span></span><span style=\"font-size: 15px;\"> </span></p>\r\n<ul>\r\n<li><span style=\"font-size: 15px;\"><span>Compiling appeals and collecting for hospital/facility component</span><span> with general knowledge of insurance follow</span><span>-</span><span>up</span></span><span style=\"font-size: 15px;\"> </span></li>\r\n<li><span style=\"font-size: 15px;\"><span>Experience with billing and collection systems such as CUBS, Meditech, Cerner etc.</span></span><span style=\"font-size: 15px;\"> </span></li>\r\n</ul>\r\n<p><br></p>\r\n<p><span style=\"color: #222222; font-size: 15px;\"><span>ABOUT CAF: </span></span><span style=\"color: #222222; font-size: 15px;\"> </span></p>\r\n<p><span style=\"color: #222222; font-size: 15px;\"><span>CAF is a fast-growing revenue cycle agency exclusively serving hospitals, and conveniently located at the intersection of the 405 and 110 freeways. We utilize amazing customer service to help hospitals bill, service and collect more of the money they are due, so they may continue to provide critical healthcare services to their patients. Our team members strive to be better every single day, to do quality work, and to make a lasting impact on their lives and the lives of others. </span></span><span style=\"color: #222222; font-size: 15px;\"> </span></p>\r\n<p><span style=\"color: #222222; font-size: 15px;\"><span> </span></span><span style=\"color: #222222; font-size: 15px;\"> </span></p>\r\n<p><span style=\"color: #222222; font-size: 15px;\"><span>COMPENSATION &amp; BENEFITS </span></span><span style=\"color: #222222; font-size: 15px;\"> </span></p>\r\n<p><span style=\"color: #222222; font-size: 15px;\"><span>Full-time position.  Pay commensurate with experience. Paid training.  Generous paid vacation, holidays, 401k, Aflac supplemental insurance (at employee expense), and monthly bonus opportunities for those who qualify. No company paid medical benefits at this time. Plenty of growth opportunities for friendly, focused, results-driven people. </span></span><span style=\"color: #222222; font-size: 15px;\"> </span></p>",
    "compensation": "DOE",
    "departmentId": "18441",
    "locationType": "0",
    "seekPromoted": false,
    "jobCategoryId": null,
    "jobOpeningName": "Appeals Specialist",
    "departmentLabel": "Insurance Recovery",
    "jobOpeningStatus": "Open",
    "minimumExperience": "Mid-level",
    "jobOpeningShareUrl": "https://caf.bamboohr.com/careers/40",
    "employmentStatusLabel": "Full-Time"
  }
}