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Randstad is seeking qualified individuals for the role of Appeals Associate for a large healthcare company to process Medicare Claims. This opportunity will expose the right candidate to a great working environment to demonstrate their skills and expertise within a rapidly growing company in the HealthCare industry.
Responsibilities include the following:
-Receives documents, investigates, refers and coordinates appeals
-Review appeal document to determine member or providers request
-Ability to identify appeal type; Expedited, Standard Pre Service and Post Service appeals
-Review all files/cases sent to Part C Appeals reviewed to determine nature of the document, and routed to the proper work stream
-Initiates case files for each appeal. Researches and assesses appeal.
-Research and analyze Medicare claims and related material including customer history.
-Compose formal letters of redeterminations and other issues.
-Appropriately use system for tracking/trending purposes.
-Keep abreast of all changes/updates regarding Medicare policy and departmental guidelines.
Working hours: 8 AM - 5 PM
The basic qualifications are as follows:
-Requires 2 years' experience in billing, claims, customer service or health insurance.
-Familiarity with state and federal regulations, medical terminology and coding.
-Excellent interpersonal skills needed to promote a positive work environment.
-Excellent written and oral communication skills.
-Flexible and able to adapt to business needs. Able to work overtime as needed.
-Strong organizational skills, detail oriented to ensure accurate and timely completion of work products.
-Must be detail oriented
If you are interested in this long-term temporary position and meet the requirements and qualifications of these positions, please visit www.randstadusa.com then click on: Job seekers > Create account.
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law.