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Appeals Specialist

2 months ago

Miami, Florida, United States BCforward Full time
About the Role

BCforward is seeking a highly motivated Appeals Specialist to support our clients in the healthcare industry. As an Appeals Specialist, you will play a critical role in ensuring that appeals, disputes, and reconsiderations are processed in accordance with state and National Committee for Quality Assurance (NCQA) requirements.

Key Responsibilities
  • Appeals Processing: Supports the documentation and processing of appeals, disputes, and reconsiderations to ensure they are in accordance with state and National Committee for Quality Assurance (NCQA) requirements.
  • Data Entry: Performs data entry to support the tracking, logging, and processing of appeals, disputes, and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures.
  • Correspondence and Documentation: Prepares correspondence for appeals, disputes, and reconsiderations and maintains documentation files.
  • Research and Investigation: Reviews and investigates appeals, disputes, and reconsiderations requests to determine applicable follow-up.
  • Case File Preparation: Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes, and reconsiderations.
  • Trend Analysis and Reporting: Gathers appeals, disputes, and reconsiderations data to track and report on trends and final outcomes to the team.
Requirements
  • Knowledge of Appeals Process: Knowledge of appeals, disputes, and reconsiderations process.
  • Medical Office Experience: Medical Office Experience.
  • Prior Authorization Building: Prior Authorization building.
  • Healthcare Claims: Healthcare Claims.
  • Medicaid/Medicare/Ambetter Knowledge: Medicaid/Medicare/Ambetter knowledge.
  • Healthcare Background: Healthcare Background.
  • Medical Assistant: Medical Assistant.
  • Excel, Microsoft: Excel, Microsoft.
Benefits

BCforward offers a comprehensive benefits package to eligible employees, including major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.