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Associate Specialist, Appeals & Grievances
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Job Description
- Req#: 300001597916129
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Competitive benefits and compensation package
- Chance to make a positive impact on member and provider satisfaction
- Engage in meaningful work by resolving claims issues and member complaints
- Work within established standards and guidelines set by regulatory bodies
What to Expect (Job Responsibilities):
- Enter denials and requests for appeals into the information system and prepare documentation for further review
- Research claims issues utilizing systems and other available resources
- Assure timeliness and appropriateness of appeals according to state, federal, and employer guidelines
- Request and obtain medical records, notes, and/or detailed bills as appropriate to assist with research
- Prepare responses to member appeals and grievances, generating and mailing denial letters
What is Required (Qualifications):
- At least 1 year of experience in claims and/or 1 year of customer/provider service experience in a healthcare setting, or equivalent combination of relevant education and experience
- Customer service experience
- Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines
- Effective verbal and written communication skills
- Proficiency in Microsoft Office suite/applicable software programs
How to Stand Out (Preferred Qualifications):
- Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace, and/or other government-sponsored program) or medical office/hospital setting
- Completion of a healthcare-related vocational program (i.e., certified coder, billing, or medical assistant)
#HealthcareServices #ClaimsManagement #CustomerService #CareerOpportunity #CompetitiveBenefits
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