Appeals Specialist

Description

Home
Search Jobs
Job Description

Appeals Specialist

Contract: Phoenix, Arizona, US

Salary: $20.00 Per Hour

Job Code: 349594

End Date: ********
Days Left: 3 hours left

Apply

PR:$19/hr -$20/hr

About the Role:
We are looking for a dedicated individual to join our team at Phoenix, AZ office as a Case Processor.
The primary responsibility of this role will be processing A&G cases, as well as handling mail duties.
Responsibilities:

Review and resolve member and provider complaints in accordance with CMS standards
Research and resolve appeals, disputes, grievances, and complaints from client members, providers, and outside agencies
Review claims appeals and grievances using support systems to determine outcomes
Request and review medical records, notes, and bills to formulate conclusions
Contact members/providers through written and verbal communication
Prepare appeal summaries, correspondence, and document findings
Compose all correspondence accurately and in accordance with regulatory requirements
Research claims processing guidelines, provider contracts, fee schedules, and system configurations
Resolve and prepare responses to provider reconsideration requests and requests for claim adjustments
Education Qualification :

High School Diploma or equivalency
Required Skills:

Minimum 2 years of operational managed care experience
Health claims processing background
Familiarity with claims denials and appeals processing
Strong verbal and written communication skills
Job Requirement

claims denials
appeals processing
resolve appeals
medical records
Reach Out to a Recruiter
Recruiter
Email
Phone
Srujan R
********

Apply Now