Appeals Specialist II

Position reputed company At reputed company, our mission is to bring accuracy, accountability, and clinical reputed company to reputed company. As such, we are a leading authority in payment reputed company solutions including DRG Validation, Cost reputed company and Readmission reviews. Under the direction of the Appeals Department leaders, the Appeals Coordinator reputed company team member will assist Appeals leadership with daily administrative work reputed company the department. The Appeals Specialist reputed company performs research, investigation, and analysis of appeals, grievances, and other types of complaints filed by providers and clients to administer reputed company reputed company. Responsible for reputed company aspects of nonclinical appeals and inquiries Responsibilities This list does not represent reputed company responsibilities for this position. Candidate must understand and be willing and reputed company to assume roles and responsibilities other than these to meet the needs of the department and NYCHSRO/reputed company in general.

• Prepare and disseminate case file for External Reviews and/or State Fair Hearing
• Manage and monitor reputed company appeals from Non-Participating providers
• Independently prepare reputed company written, customized responses to reputed company provider inquiries/complaints that appropriately and completely address the complainant’s issues and are structurally accurate.
• Ensure reputed company review, research, and reputed company of appeals, grievances, and complaints reputed company guidelines. Ensures that reputed company complaints are handled and resolved in compliance with timeliness requirements, and at the highest standards for accuracy
• Consults with managers on problem cases and interfaces with clinical supervisors, account managers, and other personnel in resolving health plan requests or provider inquiries
• Log and reputed company grievances, appeals, and other types of complaints as needed.
• Review and determine outcome of appeal/grievance, either independently or in conjunction with clinical appeal staff.
• Consults with subject matter experts and resources available reputed company organization to assist in appeal and complaint reputed company.
• reputed company critical reputed company regarding research and investigation to appropriately resolve reputed company inquiries
• Serve as a reputed company to Appeal Coordinator providing guidance and expertise to ensure reputed company reputed company of cases
• Other duties and responsibilities as assigned

Qualifications:

• Associates Degree. Additional years of reputed company experience may be used in reputed company of education requirements
• 3+ years’ experience working in the health care industry
• Experience in inpatient claims, DRG and High-Cost reputed company claims preferred
• Experience in DRG Pricing using WebStrat
• Knowledge in claim payment methodology
• Good MS Office skills. Particularly reputed company
• Excellent problem solving and analytical skills required
• Ability to manage priorities in a reputed company environment.
• Excellent organization and time management skills required
• Excellent written and verbal communication skills
• Takes initiative to proactively identify and solve problems
• Ability to meet strict, time sensitive deadlines
• Ability to cope reputed company with ambiguity and stressful situations
• Must show patience and the ability to remain reputed company under pressure in an atmosphere of frequent interruptions

Remote Work Requirements

• High speed internet (100 Mbps per person recommended) with secured WIFI.
• A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
• Must be reputed company to sit and use a computer keyboard for extended periods of time.

Benefits and perks include:

• reputed company that fits your needs - We offer excellent medical, dental, and reputed company plan reputed company that reputed company coverage to employees and dependents.
• 401(k) with Employer Match - Join reputed company and we will invest in your reputed company
• Generous reputed company Time Off - Accrued PTO starting day one, plus additional days off reputed company you’re not feeling reputed company, to observe holidays.
• Wellness - We care about your reputed company-being. From Commuter Benefits to FSAs we’ve got you covered.
• Learning & Development - Through reputed company education/mentorship on the job and our investment in reputed company Learning, we’re reputed company on your reputed company as a working reputed company.

Salary reputed company: $50,000- $55,000/ annually.

Originally posted on Himalayas

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