We are seeking a Clinical Appeals Specialist to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. The Clinical Appeals Specialist plays an essential role managing and resolving clinical appeals related to insurance claims and member care. The Clinical Appeals Specialist ensures that appeals are thoroughly reviewed, accurately documented, and effectively communicated to insurance providers, healthcare professionals, and members.
Skills for this role
Clinical AppealsMedical BillingHealthcare Claims ProcessingMedical TerminologyClinical DocumentationInsurance Claim ProceduresEHR ManagementClaims Management SoftwareMedical CodingMedical Denial Root Cause AnalysisMedical Record RetrievalDocumentation Review
Certifications
CPCCCS
Requirements
Bachelor's degree in Health Administration, Nursing, or a related healthcare field
2 years experience in clinical appeals, medical billing, or healthcare claims processing
Strong understanding of medical terminology, clinical documentation, and insurance claim procedures
Proficiency with electronic health records (EHR) systems and claims management software
Excellent written and verbal communication skills
Bilingual (English/Spanish) preferred
Master's degree in Health Administration, Nursing, or a related healthcare field (preferred)
Certification in Medical Coding (e.g., CPC, CCS) or Healthcare Compliance (preferred)
Living in Miami, FL
Miami blends sun-soaked coastal living with a fast-paced, multicultural energy. Nurses relocating here find year-round warmth, Latin-Caribbean flavor, and bustling healthcare corridors. Whether you prefer the high-rise condos of Brickell or the beach-town feel of Miami Beach, the city delivers a vibrant lifestyle where ocean breezes meet 24/7 urban excitement.
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