Quadax, Inc.

Appeals Specialist

Quadax, Inc.  •  Middleburg Heights, OH (Onsite)  •  21 days ago
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Job Description

Responsibilities:

  • Review assigned denials and EOB’s for appeal filing information. Gather any missing information.
  • Review case history, payer history, and state requirements to determine appeal strategy.
  • Obtain patient and/or physician consent and medical records when required by the insurance plan or state.
  • Gather and fill out all special appeal or review forms.
  • Create appeal letters, attach the materials referenced in the letter, and mail them.
  • Coordinate phone hearings with the insurance company, patient, and physician.
  • Comply with all 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP’s.
  • Meet appeal filing deadlines by completing assigned worklist tasks in a timely matter and/or reporting to management when assistance is needed to complete the tasks.
  • Report all insurance company or state requirements and denial trend changes to the Team Leader and Reimbursement Manager.
  • Participate in team and appeal meetings by sharing the details of cases worked.
  • Act as a backup on answering incoming telephone calls as needed.
  • May undertake special projects assigned by the Team Leader or Reimbursement Manager.
  • Ability to meet predetermined Productivity Goals based on the level of Appeal.
  • Ability to meet Quality Standard in place (90% or greater).
  • Other duties as assigned.

Qualifications:

  • High School diploma or GED
  • Minimum of four years health insurance billing experience
  • Knowledge of managed care industry including payer structures, administrative rules, and government payers
  • Proficient in all aspects of reimbursement
  • Ability to maintain confidentiality
  • Detail oriented
  • Possess excellent written and verbal communication skills
  • Able to establish priorities, work independently, and proceed with objectives without supervision.
  • Proficient in using Microsoft Excel and Word
Quadax, Inc.

About Quadax, Inc.

Quadax is a trusted leader in revenue cycle management (RCM), delivering innovative solutions that help healthcare providers nationwide accelerate payments, boost reimbursements, and improve financial performance. Our proprietary, industry-leading RCM solutions—spanning advanced in-house billing software, outsourced billing services, and integrated clearinghouse technology—deliver actionable insights and measurable results.

RCM/Billing: Quadax solutions are laboratory- and pathology-specific, designed to improve efficiency, reduce denials, and maximize revenue for all laboratory specialties ranging from clinical to esoteric testing, and DME companies. Services include our integrated clearinghouse to further optimize results. Our experienced teams provide the expertise and support needed to drive better financial outcomes.

EDI Clearinghouse: Our smart platform combines AI-powered analytics, machine learning, and cutting-edge clearinghouse technology to give healthcare organizations greater control over claims, denials, appeals, audits, and revenue integrity. We serve hospitals, labs, and providers nationwide, leveraging long-standing relationships with thousands of payers and decades of industry experience to drive superior outcomes.

What sets us apart? Nearly 40% of our team brings more than a decade of RCM experience, ensuring clients receive personalized support and strategic guidance every step of the way.

At Quadax, your success is our priority. As a trusted RCM leader with over 50 years of experience, deep industry expertise, and advanced technology, we deliver comprehensive, end-to-end solutions that achieve results. Our proven approach is designed to optimize financial performance, improve operational efficiency, and drive better outcomes for healthcare organizations nationwide.

Discover why leading healthcare organizations rely on Quadax for smarter revenue cycle solutions at Quadax.com.

Industry
Healthcare & Social Services
Company Size
501-1,000 employees
Headquarters
Cleveland , Ohio
Year Founded
1973
Website
quadax.com
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