In this key remote position, you will evaluate provider disputes, reconsideration requests, and claim appeals across Medicaid health plans. Working standard Central Time daytime hours, you will review cases within CENPAS and analyze claims data in AMISYS to determine appropriate resolutions, modify prior authorizations, and respond to claims and utilization management inquiries. Once fully trained, you will maintain high-quality standards by completing approximately 50 case reviews per day while achieving a 95% or higher quality rating. If you bring strong knowledge of claims, medical coding, or authorizations along with rapid data entry skills, this contract role offers an ideal environment to broaden your expertise across multiple health plans.
salary: $22.99 - $23 per hour
shift: First
work hours: 7 AM - 3:30 PM
education: High School
Responsibilities
Position Summary:
Evaluate provider reconsideration requests, process Medicaid claim appeals in AMISYS, modify authorizations in CENPAS, and resolve provider billing disputes.
Key Responsibilities:
- Transfer and evaluate case files from CENPAS to review provider disputes and reconsideration requests.
- Analyze claims and authorization records in AMISYS to determine accurate appeal resolutions.
- Modify prior authorizations and respond to claims and utilization management inquiries.
- Complete approximately 50 case reviews daily while maintaining a 95% or higher monthly quality average.
- Participate in virtual team huddles, 1:1 leadership check-ins, and continuous process training.
- High School Diploma or GED required.
- Minimum 2 years of experience in healthcare appeals, claims processing, billing/coding, or authorizations.
- Familiarity with claims processing and authorization software (such as AMISYS, CENPAS, TruCare).
- Fast and accurate data entry skills (minimum typing speed of 40 WPM).
- Dedicated home office setup with ability to work standard CST business hours.
Skills
Qualifications
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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
