Appeals Specialist

Why join us?

We're on a mission to empower people with disabilities to do what they once did or never thought possible. As the world-leader in assistive communication solutions, we empower our customers to express themselves, connect with the world, and live richer lives.

At Tobii Dynavox, you can grow your career within a dynamic, global company that has a clear, impactful purpose - with the flexibility to also do what truly matters to you outside of work. What's more, you'll be part of a work culture where collaboration is the norm and individuality is welcomed.

As a member of our team, you'll have the power to make it happen. You'll solve challenges, deliver solutions and develop new, efficient processes that make a direct impact on our customers' lives.

What you'll do:

The Appeals Specialist researches, reviews and responds to member and/or provider appeal issues in accordance with departmental policies and procedures, and outside regulatory agency requirements. Serves as a resource for internal and external questions related to member and provider appeal issues, including identifying needed system changes and contacting other areas to implement those changes.

As an Appeals Specialist, you will be responsible for:

Case Management

• Maintaining communication with SLPs on funded cases and instructing SLPs on document preparation and funding policies and regulations.

• Working with insurance providers, government agencies, and educational institutions to place new product, repair or rental orders.

• Tracking funding authorization cases ensuring requests are resolved to completion in a timely manner.

• Utilizing on-line resources and maintaining frequent communication with funding agencies to verify eligibility.

• Reviewing prior authorization documents against third party payer criteria

• Researching previous orders and payment history/DSOs for any repair or new order requests Enter and complete orders in the order management system database.

• Serving as a client advocate by communicating with clients and family members on funding requests and co-payment requirements, representing client's case with third party insurance providers and troubleshooting any problems to resolution

• Resolving third party denials and provide consultation to finalize difficult funding cases.

• Alerting supervisor of potential third-party payer challenges Perform various other duties as assigned.

Appeals

• Reviews and evaluates appeal requests and inquiries in order to identify and classify member and provider appeals.

• Using internal systems, determines eligibility, benefits, and prior activity related to the claims payment or service denial issues related to appeal requests.

• Completes cases within State and Commercial payer timeframes.

• Utilizes the appropriate systems and resources to communicate, in writing, findings, decisions, rationale for denial or approval and follow-up on corrective action as requested.

• Identifies and requests internal/external documentation as needed for medical necessity appeal issues and submit cases to appropriate areas for review.

• Facilitates processing of appeal to independent review organization (IRO)

• Serves as a resource/training for appeals unit staff and as a resource for internal/external questions related to appeals processing issues.

• Researches, responds and makes recommendations for possible resolution to issues.

• Reviews complex and sensitive cases. Researches and replies to executive inquiries.

• Contacts customer or provider by phone for additional information or clarification. Follows up with written correspondence.

• Attends meetings and/or participates in special projects as needed.

• Monitors and tracks payer denial trends and reports applicable information to internal and external department staff.

• Performs other duties as assigned.

Minimum Qualifications:

• Master's degree in Speech-Language Pathology, Communication Sciences and Disorders, or a related healthcare field required.

• Equivalent clinical or healthcare experience may be considered in place of specific degree requirements.

• Knowledge of Healthcare process

What you'll bring:

• Prior experience with augmentative and alternative communication (AAC) devices or assistive technology is strongly preferred.

• Demonstrated problem-solving ability; able to think creatively and develop innovative solutions.

• Excellent persuasive writing skills with the ability to present clear, evidence-based arguments.

• Proven ability to produce well-structured justifications and advocacy documents.

• Proficiency in Microsoft Word and Excel; familiarity with Access a plus.

• Strong communication skills (written, verbal, and interpersonal).

• Ability to manage multiple priorities effectively.

• Self-motivated with the ability to work independently and collaboratively within a team.

• Familiarity with healthcare systems and processes.

• Knowledge of Medicaid policies and procedures preferred.

• Effective time management and organizational skills.

• Strong command of grammar and professional writing standards.

• Professional phone etiquette and customer service skills.

Work Environment:

• Ability to work with interruptions

• Thrive in a fast-paced work setting

Apply today!

We believe in empowering individuals - including our own employees - to reach their full potential. So, if you want to change lives while growing your own career, we'd love to hear from you.