Appeals Specialist I

3 weeks ago

Phoenix, United States Professional Management Enterprises Full time
Appeals Specialist I to be responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid.

This position is fully onsite. Works schedule is M-F 8am-5pm.
Location: 5055 E Washington St Suite 210, Phoenix, AZ 85034

KNOWLEDGE/SKILLS/ABILITIES
  • Primarily processing Appeals & Grievances cases.
  • Open/receive/scan mail.
  • Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from members, providers and related outside agencies.
  • Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.
  • Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Healthcare guidelines.
  • Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested.
  • Research claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.

REQUIRED EXPERIENCE:
  • Min. 2 years operational managed care experience (call center, appeals or claims environment).
  • Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria.
  • Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials.
  • Strong verbal and written communication skills

REQUIRED EDUCATION:
High School Diploma or equivalency

  • Healthcare - Appeals Specialist I

    5 days ago

    Phoenix, United States APN Consulting Full time

    Job Title: Appeals Specialist I Location: Remote (Must be located in Arizona) Duration: 6 MonthsJob Description: 100% remote position Monday-Friday 8:30am-5pm. Need to be local to Arizona working in MST • Role will be primarily processing the intake of appeals and grievances for both Members and Providers • Role will be responsible for reviewing,...

  • Healthcare - Appeals Specialist I

    7 days ago

    Phoenix, United States APN Consulting, Inc Full time

    Job Title: Appeals Specialist ILocation: Remote (Must be located in Arizona)Duration: 6 Months Job Description: 100% remote position Monday-Friday 8:30am-5pm.Need to be local to Arizona working in MST• Role will be primarily processing the intake of appeals and grievances for both Members and Providers• Role will be responsible for reviewing,...

  • Healthcare - Appeals Specialist I

    3 weeks ago

    Phoenix, United States APN Consulting Full time

    Job Title: Appeals Specialist I Location: Phoenix, AZ 85034 (Onsite M-F) Duration: 6 MonthsJob Description: On-site Monday to Friday 8am-5pm at the Phoenix, AZ office 5055 E Washington St Suite 210. Phoenix, AZ 85034 • Role will be primarily processing A&G cases • Will also be required to open/receive/scan mail as a part of job duties Job...

  • Healthcare - Appeals Specialist I

    3 days ago

    Phoenix, United States APN Consulting Full time

    Job Title: Appeals Specialist I Location: Remote (Must be located in Arizona) Duration: 6 MonthsJob Description: 100% remote position Monday-Friday 8:30am-5pm. Need to be local to Arizona working in MST Role will be primarily processing the intake of appeals and grievances for both Members and Providers Role will be responsible for reviewing, researching,...

  • Healthcare - Appeals Specialist I

    6 days ago

    Phoenix, AZ, United States APN Consulting, Inc Full time

    Job Title: Appeals Specialist I Location: Remote (Must be located in Arizona) Duration: 6 Months   Job Description: 100% remote position Monday-Friday 8:30am-5pm. Need to be local to Arizona working in MST • Role will be primarily processing the intake of appeals and grievances for both Members and Providers • Role will be responsible for reviewing,...

  • Appeals Specialist

    4 weeks ago

    Phoenix, United States CO Full time

    **Appeals Specialist I** **Phoenix, AZ** **6+ Months** **On-site Monday to Friday 8am-5pm at the Molina Phoenix, AZ office 5055 E Washington St Suite 210. Phoenix, AZ 85034** - Role will be primarily processing A&G cases **- Will also be required to open/receive/scan mail as a part of job duties** Job Summary Responsible for reviewing and resolving...

  • Appeals Specialist I

    3 weeks ago

    Phoenix, United States Integrated Resources Full time

    Job Summary Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Responsibilities: " Responsible for the comprehensive research and resolution of...

  • Appeals Specialist

    3 weeks ago

    Phoenix, United States Collabera Full time

    Description Home Search Jobs Job Description Appeals Specialist Contract: Phoenix, Arizona, US Salary: $20.00 Per Hour Job Code: 349594 End Date: 2024-06-20 Days Left: 28 days, 3 hours left Apply PR:$19/hr -$20/hrAbout the Role: We are looking for a dedicated individual to join our team at Phoenix, AZ office as a Case Processor. The primary...

  • Appeals Specialist

    3 weeks ago

    Phoenix, United States Collabera Full time

    Description Home Search Jobs Job Description Appeals Specialist Contract: Phoenix, Arizona, US Salary: $20.00 Per Hour Job Code: 349594 End Date: 2024-06-20 Days Left: 27 days, 3 hours left Apply PR:$19/hr -$20/hrAbout the Role: We are looking for a dedicated individual to join our team at Phoenix, AZ office as a Case Processor. The primary...

  • Appeals Specialist

    3 weeks ago

    Phoenix, United States Collabera Full time

    Description Home Search Jobs Job Description Appeals Specialist Contract: Phoenix, Arizona, US Salary: $20.00 Per Hour Job Code: 349594 End Date: 2024-06-20 Days Left: 26 days, 3 hours left Apply PR:$19/hr -$20/hrAbout the Role: We are looking for a dedicated individual to join our team at Phoenix, AZ office as a Case Processor. The primary...

  • Appeals Specialist

    3 weeks ago

    Phoenix, United States Collabera Full time

    Description Home Search Jobs Job Description 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/hrAbout the Role: We are looking for a dedicated individual to join our team at Phoenix, AZ office as a Case Processor. The primary...

  • Appeals Specialist

    2 weeks ago

    Phoenix, United States Collabera Full time

    Description Home Search Jobs Job Description Appeals Specialist Contract: Phoenix, Arizona, US Salary: $20.00 Per Hour Job Code: 349594 End Date: 2024-06-20 Days Left: 23 days, 3 hours left Apply PR:$19/hr -$20/hrAbout the Role: We are looking for a dedicated individual to join our team at Phoenix, AZ office as a Case Processor. The primary...

  • Appeals Specialist

    2 weeks ago

    Phoenix, United States Collabera Full time

    Description Home Search Jobs Job Description Appeals Specialist Contract: Phoenix, Arizona, US Salary: $20.00 Per Hour Job Code: 349594 End Date: 2024-06-20 Days Left: 21 days, 3 hours left Apply PR:$19/hr -$20/hrAbout the Role: We are looking for a dedicated individual to join our team at Phoenix, AZ office as a Case Processor. The primary...

  • Appeals Specialist

    2 weeks ago

    Phoenix, United States Collabera Full time

    Description Home Search Jobs Job Description Appeals Specialist Contract: Phoenix, Arizona, US Salary: $20.00 Per Hour Job Code: 349594 End Date: 2024-06-20 Days Left: 20 days, 3 hours left Apply PR:$19/hr -$20/hrAbout the Role: We are looking for a dedicated individual to join our team at Phoenix, AZ office as a Case Processor. The primary...

  • Appeals Specialist

    2 weeks ago

    Phoenix, United States Collabera Full time

    Description Home Search Jobs Job Description Appeals Specialist Contract: Phoenix, Arizona, US Salary: $20.00 Per Hour Job Code: 349594 End Date: 2024-06-20 Days Left: 20 days, 3 hours left Apply PR:$19/hr -$20/hrAbout the Role: We are looking for a dedicated individual to join our team at Phoenix, AZ office as a Case Processor. The primary...

  • Appeals Project Specialist

    1 month ago

    Phoenix, United States SA Technologies Inc. - Asia Full time

    Role : Appeals Project Specialist Estimated Duration : 6+ months Location: Phoenix, AZ (hybrid) Position Description Reviewing medical records and writing administrative reviews- looks at recommendations by doctors, learning Client rules and they'll be writing recommendations. Communicating with families so they will need to have verbal and written...

  • Appeals Project Specialist

    2 weeks ago

    Phoenix, United States SA Technologies Inc. - Asia Full time

    Role : Appeals Project Specialist Estimated Duration : 6+ months Location: Phoenix, AZ (hybrid) Position Description Reviewing medical records and writing administrative reviews- looks at recommendations by doctors, learning Client rules and they'll be writing recommendations. Communicating with families so they will need to have verbal and written...

  • Claims Appeals and Grievances Specialist

    3 weeks ago

    Phoenix, United States Morgan Stephens Full time

    Job Posting: Claims Appeals and Grievances Specialist Job Summary The Claims Appeals and Grievances Specialist is responsible for reviewing and resolving member and provider complaints and communicating resolutions to members and providers (or their authorized representatives) in accordance with the standards and requirements established by the Centers for...

  • Claims Appeals and Grievances Specialist

    2 weeks ago

    Phoenix, United States Morgan Stephens Full time

    Job Posting: Claims Appeals and Grievances SpecialistJob Summary The Claims Appeals and Grievances Specialist is responsible for reviewing and resolving member and provider complaints and communicating resolutions to members and providers (or their authorized representatives) in accordance with the standards and requirements established by the Centers for...

  • Law Clerk I Brian Y. Furuya 2024-2025

    2 weeks ago

    Phoenix, United States Arizona Court of Appeals Full time

    **2024 - 2025 JUDICIAL LAW CLERKSHIP**: **Title**:Law Clerk I **Grade**:Fixed Rate **Reports To**:Judicial Officer **Department**:Judicial Chambers **Exempt Status**:Exempt **Status**:Full-Time (40 hours per week) **Schedule**:Monday-Friday 8 hours per day **Salary**:$60,170 First Review Date: Thursday, June 13, 2024; Open Until Filled **Minimum...