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Medical Claim Appeal Consultant

2 weeks ago


Cambridge, Massachusetts, United States Ternium Full time

Job Description

As a Medical Claim Appeal Consultant at Ternium, you will leverage your legal expertise to represent healthcare providers in disputes with medical insurance carriers and managed care organizations. Your primary responsibility will be to analyze denied claims, identify key issues, and develop persuasive appeal arguments to achieve successful resolutions.

About the Role

  • Analyze denied medical claims to identify key issues and areas for improvement
  • Develop and present compelling appeal arguments to insurance organizations and benefit administrators
  • Collaborate with provider representatives and enhanced resolution units to resolve complex issues
  • Leverage payor provider manuals and managed care contracts to inform decision-making

Key Skills

  • Strong analytical and problem-solving skills
  • Excellent written and verbal communication skills
  • Ability to work independently and as part of a team
  • Attention to detail and ability to prioritize within a dynamic environment
  • Knowledge of HIPAA and company policies and regulations

Benefits

  • Full-time remote work opportunity
  • Competitive starting salary ($55,000-$65,000 per year)
  • 401(k) with corporate match
  • Dental insurance
  • Employee assistance program
  • Flexible schedule
  • Health insurance
  • Vision insurance
  • Life insurance
  • Paid time off
  • Bar Due reimbursement
  • Bonus opportunities

EEO Statement

Ternium is committed to equal employment opportunity and does not discriminate based on protected categories. We strive to create an inclusive work environment that values diversity and promotes professional growth.