Employer Industry: Healthcare Services

Why Consider this Job Opportunity:
- Competitive pay up to $80,000
- Opportunities for career advancement and growth within the organization
- Remote work flexibility available
- Comprehensive benefits package including health, dental, and vision insurance
- Chance to work with a supportive and collaborative team
- Make a positive impact on improving customer health and vitality

What to Expect (Job Responsibilities):
- Review and process Medicare Appeals, Grievances, coverage determinations, and Organization Determinations
- Research and understand the reason for claim denials and determine appropriate actions
- Communicate appeal information to members, providers, and internal/external parties
- Support the implementation of new processes and identify trends for improvement
- Assist with monitoring, inquiries, and audit activities as required

What is Required (Qualifications):
- Licensed Practical Nurse (LPN) or Registered Nurse (RN) certification
- 3-5 years of experience in Medicare Advantage Health Plans or related healthcare setting
- Working knowledge of Medicare Advantage, Original Medicare, and Medicaid appeal regulations
- Proficiency in Microsoft Office products and ability to prioritize workflow effectively
- Strong written and oral communication skills with attention to detail and critical thinking

How to Stand Out (Preferred Qualifications):
- Experience in handling complex inquiries and requests for service in a healthcare-related setting
- Knowledge of ICD9, ICD10 coding systems

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