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Claims Review Specialist
2 months ago
Position Overview: We are looking for a meticulous and empathetic Claims Review Specialist to become a part of a reputable Healthcare Organization. In this capacity, you will be tasked with evaluating and managing appeals and grievances submitted by patients and healthcare providers, ensuring timely resolution in compliance with regulatory standards.
Key Responsibilities:
- Review and verify that all documentation submitted is eligible for appeal.
- Organize and prioritize appeals for entry into the system following departmental protocols.
- Accurately input appeal and claim data into the appeals management system.
- Attach all necessary documentation to the appropriate case files.
- Communicate effectively regarding any special handling requirements for each appeal.
- Maintain production standards and monitor error rates.
- Provide assistance and support to team members as needed.
- Adhere to HIPAA regulations in all communications and processes.
- Perform additional duties as assigned.
Qualifications:
- High school diploma or equivalent required.
- Typing proficiency of 40 words per minute.
- Familiarity with Microsoft Office Suite, particularly Outlook, Excel, and Word.
- Exceptional attention to detail with a high degree of accuracy.
- Ability to perform tasks efficiently in a paperless environment using multiple monitors.
- Strong problem-solving skills and independent work capability.
- Excellent organizational, planning, and time management skills.
- Effective communication skills.
Application Process: To express your interest in this opportunity, please follow the application instructions provided by CornerStone Staffing.
