Appeals Specialist

Location: Remote
Compensation: Hourly
Staff Reviewed: Thu, Jul 11, 2024
This job expires in: 29 days

Job Summary

A company is looking for a Specialist in Appeals & Grievances.

Key Responsibilities:
  • Review and resolve member and provider complaints in accordance with established standards
  • Research and resolve appeals, disputes, and grievances from members and providers
  • Contact members/providers, prepare appeal summaries, and compose correspondence accurately

Required Qualifications:
  • High School Diploma or equivalency
  • Minimum 2 years operational managed care experience
  • Health claims processing background, including Medicaid and Medicare knowledge
  • Familiarity with appeals and denials processing and regulatory guidelines
  • Experience in claims processing guidelines and provider contracts

COMPLETE JOB DESCRIPTION

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