Grievance & Appeals Specialist II (Must live in Indiana)

2 weeks ago

Indianapolis, Indiana, United States CareSource Full time $40,400 - $64,700

Job Summary:

The Grievance & Appeals Specialist II reviews appeals submitted by Medicaid and Medicare providers and all future providers contracted with CareSource. This position requires candidates to live in the state of Indiana.

.

Essential Functions:

  • Prepare the appeals for clinical review and be responsible for recording and tracking on a regular basis
  • Review submitted appeals daily for validation of the appeal
  • Identify appropriate claim problem within the appeal
  • Prepare all clinical edit appeals for review by computer research, print claim from Facets system, and print off all the code descriptions to assist the reviewer in decision making for committee meetings
  • Attend and participate in Appeals Committee meetings as needed
  • Maintain spreadsheet of all appeals reviewed with the outcomes resulting from the Appeals Committee Meetings
  • Document within Facets the detailed information as to the outcome of the claim appeal
  • Identify System changes, log the ticket and track the resolution
  • Complete claim appeal through claim adjustments or letters of denials
  • Review claim appeals for possible fraud and abuse and report to SIU
  • Research and release claim appeals with other health insurance, notifying the COB unit when there is other insurance
  • Process a variety of appeals, including but not limited to: dental appeals, low difficulty appeals, non-clinical appeals – (i.e. tobacco surcharge, etc.), medically frail appeals, RCP appeals, member and provider appeals
  • Resolve assigned appeals within regulatory timeframes, achieve departmental quality expectations, and meet daily production requirements
  • Identify and log any related issues
  • Perform UAT testing when necessary
  • Perform any other job related instructions, as requested

Education and Experience:

  • High school diploma or equivalent is required
  • Associates Degree or equivalent years of relevant work experience preferred
  • Minimum of two (2) years of healthcare customer service, claims, compliance or related experience is required

Competencies, Knowledge and Skills:

  • Technical writing skills
  • Intermediate level skills in Microsoft Word & Excel with Access skills a plus
  • Communication skills (written, oral and interpersonal)
  • Multitasking ability
  • Able to work independently and within a team environment
  • Familiarity of the Healthcare field
  • Knowledge of Medicaid
  • Time Management
  • Decision-making and/or problem solving skills
  • Proper grammar skills
  • Phone etiquette skills

Licensure and Certification:

  • None

Working Conditions:

  • General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$40, $64,700.00

CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Hourly

Organization Level Competencies

  • Fostering a Collaborative Workplace Culture

  • Cultivate Partnerships

  • Develop Self and Others

  • Drive Execution

  • Influence Others

  • Pursue Personal Excellence

  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-SD1

  • Grievance/Appeals Analyst

    2 weeks ago

    Indianapolis, Indiana, United States Partnered Staffing Full time

    Company Description Kelly Services in partnership with Nissan is currently seeking high skilled individuals to fill Production Technician openings at the Nissan manufacturing plant located in Canton, MS. Job Description Kelly Services is currently seeking a Grievance/Appeals Analyst for a leading health insurance company in Downtown Indianapolis,...

  • Nurse Appeals

    5 days ago

    Indianapolis, Indiana, United States Elevance Health Full time

    Nurse AppealsLocation: IndianaVirtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.Please note that per...

  • Architectural Historian

    2 weeks ago

    Indianapolis, Indiana, United States State of Indiana Full time $60,000 - $80,000 per year

    Work for IndianaBegin a fulfilling career with the State of Indiana by joining one of the largest employers in the state, offering a range of opportunities across 60+ agencies. At the state, you'll find competitive compensation, a robust benefits package and a commitment to work-life balance. Most importantly, you'll have the chance to make a real and...

  • Remote Medical Director Indiana

    6 days ago

    Indianapolis, Indiana, United States Centene Corporation Full time

    You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.We're Hiring Remote Medical DirectorsCentene Corporation is a leading provider of...

  • Mechanical Technician II

    2 weeks ago

    Indianapolis, Indiana, United States Central Indiana Hardware Full time $40,000 - $50,000 per year

    The CIH Way — At CIH, Core Values are not a slogan, but our way of doing business. They are six foundational beliefs that reflect our company's history and culture. We begin by creating an exceptional customer and employee experience by serving first, treating everyone uniquely and focusing on the way they want to be treated. To execute this well, our...

  • Field Service Technician Level II – Indianapolis, Indiana

    5 days ago

    Indianapolis, Indiana, United States K Group Companies Full time

    Field Service Technician Level II Overview:We are seeking a dedicatedField Service Technician IIto join our team and serve our clients in theIndianapolis, IndianaareaTheField Service Technician Level IIwill not only carry out the essential responsibilities expected of a Level 1 installer but will also demonstrate advanced skills, training, certifications,...

  • Registered Respiratory Therapist-Resource

    2 weeks ago

    Indianapolis, Indiana, United States Indiana University Health Full time $70,000 - $85,000 per year

    Indiana University Health is unlike any other healthcare system and we're looking for team members who share the things that matter most to us. People who are inspired by challenging and meaningful work for the good of every patient. People motivated to do their best every day. People who are always ready to apply themselves. As one of Indiana's largest...

  • utilization payor specialist rn

    4 days ago

    Indianapolis, Indiana, United States HHC Full time

    Division:Eskenazi Health  Sub-Division: Hospital  Req ID: Schedule: Full Time Shift: Days Salary Range: Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 327-bed hospital and outpatient facilities both...

  • Systems Training Specialist II

    11 hours ago

    Indianapolis, Indiana, United States TRIMEDX Full time

    If you are wondering what makes TRIMEDX different, it's that all of our associates share in a common purpose of serving clients, patients, communities, and each other with equal measures of care and performance.Everyone is focused on serving the customer and we do that by collaborating and supporting each otherAssociates look forward to coming to work each...

  • Associate/Full Professor in Physical Activity and Brain/Mental Health

    2 weeks ago

    Indianapolis, Indiana, United States Indiana University Full time $120,000 - $180,000 per year

    Tenured Associate/Full Professor in Physical Activity and Brain/Mental HealthDual Appointment – Department of Psychology in the School of Science and School of Health and Human Sciences, Indiana University (IU) IndianapolisThe School of Science Department of Psychology and the School of Health and Human Sciences at Indiana University, Indianapolis invite...