Appeals Specialist

Immediate need for a talented Appeals Specialist. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
 
Job ID: 25-76422
 
Pay Range: $22 - $22.50/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Responsibilities: 

• As a part of our hiring process, along with an option to directly connect with a Recruiter or apply online, we now offer a texting option to enhance your candidate experience.
• Click the link below which contains the job description and a few basic questions that will help you ensure this is a good fit and expedite the shortlisting process or you can directly email me.
  https://hire.glider.ai/connect/85157957
• Completely, organize and oversee the appeal process of the unit to ensure all telephone and written appeals are processed accurately and promptly
• Coordinate all appeal functions which involve preparing summary reports, categorizing and routing medical appeals to the appropriate departments for action and acting as liaison with other units regarding appeal issues
• Accurately respond by telephone, in person, or through correspondence to all inquiries involving requests for appeals
• Determine need for obtaining additional information and notifying members and/or providers as related to the processing of appeals
• Respond to appeal requests within designated time requirements
• Acknowledge member complaints within the regulatory timeframe
• Compose letter to provider for management approval, track timeliness of response, and send follow-up letters as appropriate
• Coordinate internal quality of care referral
• Promote goodwill of our customer population through capable, efficient, caring, and composed performance
• Coordinate and maintain system of tracking member complaints and appeals which includes identification and resolution of member concerns or outcome of appeal or internal quality of care referral
• Provider support to supervisor, and appeals RN, and grievance coordinator as necessary
• Identify trends and communicate this information to the supervisor
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies
• Maintain complete confidentiality of company business
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

 
Key Requirements and Technology Experience:  

• Key skills; 2 years’ experience researching and responding to telephone and / or correspondence inquiries regarding health insurance claims/services
• Medical terminology knowledge
• Knowledge of appeals processing
• 1 year of health insurance plus 2 years of customer service experience
• Effective analytical, problem solving and research skills
• Effective organizational skills to accommodate a large volume of reference materials combined with time management skills to achieve accessibility to callers
• Effective verbal and written communication skills to include the ability to clearly express oneself in a well-modulated tone with correct grammar and attention to enunciation 
• BlueChip claims payment experience
• Ability to think clearly and maintain a professional, poised attitude under pressure
• Bi-lingual Spanish speaking
• High School Diploma

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages

#prof

J2W:CB3