Payer Audit and Appeal Specialist

The Payer Audit and Appeal Specialist handles daily activities related to medical document requests and appeals for denied Medicare, Humana Medicare, and Commercial payer claims. The role involves responding to payer audits, gathering required documentation, and conducting follow-up activities to ensure timely responses and outcomes. The specialist collaborates with the Referral Management team to obtain supporting medical records and maintains knowledge of Medicare's appeals process and LCDs.