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Appeals Specialist
4 weeks ago
Description
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Appeals Specialist
Contract: Phoenix, Arizona, US
Salary: $20.00 Per Hour
Job Code: 349594
End Date: 2024-06-20
Days Left: 25 days, 3 hours left
Apply
PR:$19/hr -$20/hr
About the Role:
- We are looking for a dedicated individual to join our team at Phoenix, AZ office as a Case Processor.
- The primary responsibility of this role will be processing A&G cases, as well as handling mail duties.
- Review and resolve member and provider complaints in accordance with CMS standards
- Research and resolve appeals, disputes, grievances, and complaints from client members, providers, and outside agencies
- Review claims appeals and grievances using support systems to determine outcomes
- Request and review medical records, notes, and bills to formulate conclusions
- Contact members/providers through written and verbal communication
- Prepare appeal summaries, correspondence, and document findings
- Compose all correspondence accurately and in accordance with regulatory requirements
- Research claims processing guidelines, provider contracts, fee schedules, and system configurations
- Resolve and prepare responses to provider reconsideration requests and requests for claim adjustments
- High School Diploma or equivalency
- Minimum 2 years of operational managed care experience
- Health claims processing background
- Familiarity with claims denials and appeals processing
- Strong verbal and written communication skills
- claims denials
- appeals processing
- resolve appeals
- medical records
- Recruiter
- Phone
- Srujan R
- srujan.rontala@collabera.com
Apply Now
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