Artificial Intelligence (AI), Billing, Claims Processing, Cloud Computing, Consulting, Data Entry, Documentation, Employee Benefits, File Maintenance, Health Plan, Healthcare, High School Diploma, Leadership, Medicaid, Medical Coding, Performance Metrics, Prepare Correspondence, Regulations, Short Messaging Service (SMS), Typing, Utilization Management
Immediate need for a talented Appeals Specialist II . This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID: 26-14451
Pay Range: $21/hr - $23/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Training: M-F CST M-F 7:00am-3:30pm (CST) / 8:00am-4:30pm (EST) - 30 min lunch
- Work Hours: M-F 7:00am-4:00pm (CST) / 8:00am-5:00pm (EST) - 1 hour lunch
- Knowledge of appeals, disputes and reconsiderations process preferred.
- Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures
- Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files
- Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up
- Knowledge of appeals, disputes and reconsiderations process preferred.
- Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures
- Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files
- Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up
- Remote with virtual assistance.
- Teams/Camera/Huddles and 1:1 with Leadership.
- Candidate will review cases in CENPAS and claims in the AMISYS system to determine resolution on provider reconsiderations.
- After full training, the performance metric is to complete 50 case reviews each day with a 95% or better overall monthly Quality average.
- The ability to gain knowledge in multiple Health Plans.
- Multiple Health Plans – Medicaid LOB only
- Transfer and evaluate cases from CenPAS and review provider disputes / reconsideration requests from providers/facilities
- Modify authorizations
- Respond to claims/UM
- Dependent upon assigned role
- Meet with leaders and start learning system/processes
- Utilization Management
- Billing/coding (typically found in medical practices/facilities), Claim processing
Key Requirements and Technology Experience:
- Knowledge with reviewing claims and authorizations, familiar with CenPAS, TruCare Classic and Cloud, Amisys
- Data Entry/ Typing 40 wpm
- Knowledgeable with Claims/Coding
- Knowledgeable with Authorizations
- High school diploma or GED
Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
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