Appeals Specialist
3 days ago
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.
- 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.
- Research techniques.
- Medicare appeals program.
- Medical terminology.
- Applicable systems and applications.
- Applicable laws, rules, and regulations.
- 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.
- Researching, analyzing, and interpreting policies and state and federal laws and regulations.
- 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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