We have other current jobs related to this field that you can find below
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Patient Intake Specialist
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Healthcare Claims Specialist
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Pharmacy Claims Specialist
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Irvine, California, United States Jobot Full timePharmacy Intake RepresentativeThis position is hosted by Jobot.About Us:Our organization is recognized as a frontrunner in infusion therapy solutions. Our services, administered by specially trained infusion nurses, are offered at various locations, including standalone facilities, physician offices, or directly in patients' homes. Each site delivers...
IQA Appeals Specialist
3 months ago
About Conduent:
Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.
Job Description:Conduent is seeking an IQA (Internal Quality Assurance) Appeals Specialist in Irvine, CA. The person in this role will train onsite for approximately 3 months and then will transition to working from home remotely.
The IQA Appeals Specialist resolves appeals in both written and verbal communications. This includes, but is not limited to, re-reviews, reconsiderations and inquiries. The IQA Appeal Specialist is responsible of monitoring various databases and maintaining TAT for all clients.
Essential Duties and Responsibilities:
- Responds to provider inquiries regarding out of network reductions made to bills.
- Responds to first level appeals via form letter.
- Coordinates with attorneys and/or Management on second level appeals.
- Negotiate as needed on high profile appeals.
- Ability to communicate with providers/facilities as needed. Communication will be via form letter or orally via phone.
- Respond via phone to providers and facilities and triage questions as needed.
- Responsible to monitor various databases and maintain TAT for all clients.
Qualifications:
- 5 years or more of Bill Review experience
- 5 years or more of Customer Service experience
Language Skills:
Ability to read and comprehend written instructions, medical reports, and correspondence from providers requesting information. Ability to correspond with clients and providers. Ability to communicate with providers or clients over the telephone to explain or review actions or methodologies applied.
Closing:Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduents ADAAA Accommodation Policy.
