Appeals Specialist

Octave Bioscience

About the Company

Octave Bioscience is at the forefront of precision care, delivering data-driven insights for neurodegenerative diseases, starting with multiple sclerosis (MS). We’re on a mission to transform clinical decision-making through predictive analytics and biomarker intelligence.

Summary:

Under general supervision of the Denial and Appeal Manager, the Appeals Specialist serves as

the primary point of contact for the timely and effective preparation and submission of 2nd level

appeals of denied services. This position involves reviewing denied claims, identifying reasons

for the continued or new denials, securing appropriate supporting documentation, and

submitting appropriate subsequent appeals or disputes (when required) to secure payment.

Critical to this position is the profound ability to effectively appeal denied technical and clinical

claims, and file payer reconsiderations. Also critical to this position is the ability to effectively

identify the core denial and write appeal letters specific to each denial as well as providing

timely and effective follow-up.

Responsibilities:

● Follow up on unpaid claims within a defined queue to conduct root cause analysis and

determine the most effective process to overturn the core denial reason(s)

● Compile all necessary information and documentation, including medical records, to

support efforts to overturn denials

● Research state and health plan specific rules and regulations on the process of

overturning denials and submitting appeals

● Maintain current and in-depth knowledge of government and third-party payer billing

regulations and guidelines

● Assist in audit preparation and ensures compliance with regulations (HIPAA, CMS,

state-specific)

Reports to: Denials & Appeals Manager

Location: Remote

Schedule: This remote position will follow a Monday–Friday schedule in alignment with our core team operations.

Salary Range

$75K - $85K + Bonus + Equity + Benefits. The successful candidate's starting base salary will be determined based on experience, qualifications and market conditions.