Position: Medical Appeals
Pay: $16.20/hr
Essential Duties and Responsibilities: - Maintains updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position
- Reviews case file documentation to determine file completeness and accuracy of data entry items
- Adjudicate reconsideration determinations for disputes between enrollees, providers, and Medicare Plans by using federal law, federal regulations, relevant contract law and other sources as defined by the client contract. These will typically be limited to reviews of appellant dismissals and technical issues such as cost-sharing and lock-in.
- write clear and accurate decision letters
- Requests additional information from Medicare Health Plans as appropriate
- Accurately updates the various systems and reviews data from other databases
- Escalates potential Privacy issues to the appropriate department
- Follows policies and procedures without deviation
- Works schedule as established by supervisor to accommodate business hours
- Assists supervisor with special projects and tasks on an as needed basis
- Perform other duties as may be assigned by management.
Minimum Requirements: - High School diploma or higher education preferred, with 2- 4 years of experience medical processing preferred
- Must have 2+ years of Medical/Healthcare Insurance experience
- Proficiency with MS Word and understanding of Excel software; excellent organizational, interpersonal, written, and verbal communication skills and ability to perform comfortably in a fast-paced, deadline-oriented work environment.
- May have additional training or education in area of specialization.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.