Appeals Specialist II

Job Summary

A company is looking for an Appeals Specialist II to assist with administrative work and manage appeals and grievances.

Key Responsibilities

• Prepare case files for external reviews and manage appeals from non-participating providers
• Ensure timely resolution of appeals and grievances while maintaining compliance with guidelines
• Consult with managers and subject matter experts to resolve health plan requests and provider inquiries

Required Qualifications

• Associates Degree or equivalent experience in the healthcare industry
• 3+ years of experience in healthcare, with a preference for inpatient claims and DRG knowledge
• Experience with DRG Pricing using WebStrat
• Proficient in MS Office, particularly Excel
• Ability to manage priorities in a complex environment