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Job Requirements of Appeal Specialist II:
-
Employment Type:
Full-Time
-
Location:
St. Louis, MO (Onsite)
Do you meet the requirements for this job?
Appeal Specialist II
Pyramid Consulting, Inc
St. Louis, MO (Onsite)
Full-Time
Immediate need for a talented Appeal Specialist II. This is a 06+months (Contract to hire) opportunity with long-term potential and is located in U.S(Remote – EST Only). Please review the job description below and contact me ASAP if you are interested.
Job ID:25-63762
Pay Range: $23 - $24/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:
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, colour, 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. You can reply STOP to cancel and HELP for help. You can access our privacy policy .
#prof J2W:CB3
Job ID:25-63762
Pay Range: $23 - $24/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:
- Shift Timing: 8am-5pm EST .
- Supports the documentation and processing of appeals, disputes, and reconsiderations to ensure they are in accordance with state and National Committee for Quality Assurance (NCQA) requirements.
- Support the team to ensure appeals, disputes and reconsiderations are reviewed and processed timely.
- Meet 50 claim reviews minimum per day.
- Prior Auth Coordinator, Appeals Coordinator, Referral Specialist, Claims Specialist.
- Meeting up with IT to set up systems.
- Face to face call .
- Shared services- manages 25-30 different states. Lots of opportunities to learn.
- Key Skills:Appeals Coordinator, Appeal Specialist, Claims, Prior Authorization .
- Knowledge of appeals, disputes and reconsiderations process preferred.
- Prior Authorization building
- Healthcare Claims
- Medical Office
- Medicare/Ambetter knowledge.
- Requires a High School diploma or GED.
- Requires 1 – 2 years of related experience.
- Excel, Microsoft .
- Knowledge of appeals, disputes and reconsiderations process preferred.
- Healthcare Background .
- Medical Assistant .
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, colour, 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. You can reply STOP to cancel and HELP for help. You can access our privacy policy .
#prof J2W:CB3
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