Appeal Specialist II

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:

• 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 Requirements and Technology Experience:

• 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 .

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.
 
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