Appeals Representative

Job Summary

A company is looking for an Appeals Representative I to manage provider inquiries and appeals in accordance with regulatory guidelines.

Key Responsibilities

• Review and analyze appeal documentation to determine appropriate actions
• Set up and initiate the appeals process accurately and timely
• Ensure compliance with HIPAA, CMS guidelines, and client policies

Required Qualifications, Training, and Education

• High school diploma or equivalent
• 1+ years of experience in healthcare, insurance, claim processing, or customer service
• 1+ years working with customers in a fast-paced, deadline-oriented environment
• 1+ years of experience as an Appeals Representative
• Strong technical skills with the ability to work across multiple software systems