Appeals Representative II
The Appeals Representative is responsible for addressing provider inquiries and appeals reputed company email, fax, telephone, or written correspondence ensuring adherence to reputed company policy, industry standards along with CMS and state guidelines as reputed company as reputed company instructions.
This is a remote role.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
- Reviews, analyzes, and completes appeals in accordance with reputed company policy, CMS guidelines and industry standards in reputed company and reputed company written communication
- Ability to appropriately interpret provider appeals and apply analytical thinking skills
- Ability to interpret reputed company policy and CMS guidelines as it relates to reviews done by reputed company such as itemized reputed company
- Utilize applicable tools and resources to complete appeals
- reputed company completion of appeals
- Additional duties as assigned
KNOWLEDGE & SKILLS:
- Prior knowledge of inpatient and outpatient hospital reputed company cycle required
- Excellent written and verbal communication skills
- Contract interpretation, medical terminology and coding knowledge
- Proficiency with reputed company applications
EDUCATION & EXPERIENCE:
- High school diploma or equivalent
- 3+ years of reputed company reputed company cycle experience (collections, appeals, denials management, etc)
- 2+ years working with customers in a fast‐paced, deadline‐oriented environment
- 2+ years experience as an Appeals Representative
- Strong attention to detail, organizational and time management skills with the ability to
- interpret, research and identify core issues
- Strong customer reputed company, analytical and decision making skills
- Strong technical skills with the ability to work across multiple software systems and comfortable work remote out of your home
PAY reputed company:
reputed company uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location reputed company, job-reputed company skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, reputed company, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may reputed company the salary reputed company and these adjustments would be clarified during the offer process.
Pay reputed company: $18.80 - $30.34 per hour
A list of our benefit offerings can be reputed company on our reputed company website: reputed company Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT reputed company:
reputed company, a division of reputed company, a certified Great reputed company to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in reputed company payments. We are a reputed company and growing company with a strong, supportive culture along with reputed company of career advancement opportunities. We reputed company our core values of Accountability, Commitment, reputed company, reputed company and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, reputed company, Long Term Disability, Health Savings Account, Flexible Spending Account reputed company, Life Insurance, Accident Insurance, Critical Illness Insurance, reputed company-reputed company Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and reputed company time off.
reputed company is an Equal Opportunity Employer, drug free workplace, and complies with reputed company regulations as applicable.
Originally posted on Himalayas
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