job description
Join Swift-Up as a Clinical Appeals and Denials Specialist and play a pivotal role in ensuring patients receive the care they deserve. In this dynamic position, you will review, analyze, and appeal denied medical claims, working closely with healthcare providers, insurance companies, and patients to resolve disputes and secure approvals. Your expertise will directly impact patient outcomes and financial reimbursement for medical services.
Based in the vibrant regions of Bali, this role offers a unique opportunity to combine your clinical knowledge with administrative skills in a supportive and fast-paced environment. If you are detail-oriented, compassionate, and driven by making a difference in healthcare, we want you on our team!
Why Swift-Up?
- Competitive salary and benefits package.
- Opportunities for professional growth and career advancement.
- Collaborative and inclusive work culture.
- Flexible work arrangements in beautiful Bali locations.
Responsibility
- Review and analyze denied medical claims to determine the root cause of denials.
- Prepare and submit appeals for denied claims, ensuring compliance with insurance policies and regulations.
- Communicate effectively with healthcare providers, insurance companies, and patients to gather necessary documentation and resolve disputes.
- Maintain accurate records of appeals, denials, and resolutions in the company’s database.
- Collaborate with clinical and administrative teams to improve claim submission processes and reduce denial rates.
- Stay updated on changes in healthcare regulations, insurance policies, and appeal procedures.
- Provide training and support to team members on best practices for handling appeals and denials.
- Monitor and report on appeal outcomes to identify trends and areas for improvement.
Qualifications
- Bachelor’s degree in Nursing, Healthcare Administration, or a related field.
- Minimum of 2 years of experience in medical billing, claims processing, or appeals management.
- Strong understanding of medical terminology, coding (ICD-10, CPT), and insurance policies.
- Excellent written and verbal communication skills, with the ability to negotiate and advocate effectively.
- Detail-oriented with strong analytical and problem-solving skills.
- Proficiency in using medical billing software and Microsoft Office Suite.
- Ability to work independently and as part of a team in a fast-paced environment.
- Certification in medical coding or appeals management is a plus.