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Appeals Specialist

1 month ago

Irvine, United States Insight Global Full time
Job DescriptionJob Description

Required Skills & Experience

- 2 years of healthcare administrative assistant experience (preferably with appeals or quality improvement experience)

- High School Diploma

Job Description

This position is responsible for activities that support Optum Clinical Services compliance with regulatory and delegation contractual requirements as outlined in the Clinical Services Compliance framework Work location: Remote/Telecommute; They can live anywhere in the USA but have to work PST hours. Work hours: Monday-Friday, 8am-5pm PST Core job functions:

• Consistently exhibits behavior and communication skills that demonstrate our company's commitment to superior customer service, including quality, care and concern with each and every internal and external customer.

• Sorts, filters and extracts data from reports and systems to create health plan required reports.

• Assist with projects geared to improve efficiency and cost savings

• Document preparation for health plan audits.

• Interaction with various health care facilities or providers for medical record request and retrievals.

• Ability to facilitate meetings with health care facilities

• Maintain data logs

• Uses, protects, and discloses our company’s patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

• Perform additional duties as assigned