Appeals Specialist

3 days ago


Baltimore, Maryland, United States J29, Inc Full time
Job Title: Appeals Specialist

At J29, Inc, we are seeking a highly skilled Appeals Specialist to join our team. As an Appeals Specialist, you will play a critical role in researching and responding to inquiries from providers, suppliers, beneficiaries, health plans, or others involved in the appeals/dispute process.

Key Responsibilities:
  • Provide exceptional customer service and respond to inquiries in a timely and accurate manner.
  • Interpret requests and determine the appropriate response or course of action to bring to resolution with minimal assistance.
  • Conduct research using online federal regulations, review Medicare and Medicaid policy and guidelines to complete an accurate and well-supported decision.
  • Screen receipts to determine the issue addressed in the correspondence and address it timely, which may involve forwarding cases to the appropriate person or entity.
  • Log receipts and enter them into the database.
  • Trend receipts/issues and schedule coordination meetings as required.
  • Prepare and send professionally worded letters, emails, or faxes.
  • Initiate, schedule, and coordinate reconsideration phone discussions between suppliers and decision makers by coordinating with appellants on schedule adherence and reschedule as needed.
Requirements:
  • High School Diploma or equivalent.
  • Three (3) years of general office experience, or college education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis.
  • One (1) year of Medicare Qualified Independent Contractor appeals experience, or one (1) year of professional business writing experience in the healthcare, customer service, or legal industries.
Working Knowledge:
  • Research techniques.
  • Medicare appeals program.
  • Medical terminology.
  • Applicable systems and applications.
  • Applicable laws, rules, and regulations.
Proficient Skills:
  • Preparing correspondence/documents using correct spelling, grammar, and punctuation.
  • Prioritizing and organizing work assignments.
  • The use of personal computers and applicable programs, applications, and systems.
Some Skills:
  • Researching, analyzing, and interpreting policies and state and federal laws and regulations.
Ability to:
  • Meet production and quality standards.
  • Multitask and meet deadlines.
  • Exercise logic and reasoning to define problems, establish facts, and draw valid conclusions.
  • Make decisions that support business objectives and goals.
  • Identify and resolve problems or refer issues appropriately.
  • Communicate effectively verbally and in writing.
  • Adapt to the needs of internal and external customers.
  • Show integrity and ethical behavior; respect confidentiality, business ethics, and organizational standards.


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