Appeals Processing Representative
Do you enjoy analyzing and researching data? Have problem solving ability? We are looking for Appeal Processing Representatives to join the team at a large healthcare insurance company. If you like the idea of putting your analytical skills to work, this position is for you!
If you have a positive, professional demeanor, this opportunity is perfect for you!
As an Appeals Processing Representative, you will work on assigned cases, review appeal documents, correct appeal types, and prioritize work load. In addition, you will document all actions taken during review for audit and reporting purposes into a client system.
Working hours: 8:00 AM - 5:00 PM
-Validate all assigned cases; review appeal documents, correct appeal types, timeframes and what is being appealed
-Independently conduct thorough review of all new member and provider correspondence by analyzing all the issues presented to determine appropriate classification
-Monitor daily reports, as well as make necessary follow-up calls to internal and external entities to all information is received or before the applicable timeframe
-Ability to consistently apply appropriate administrative and regulatory criteria for reviewing and making decisions on all non-clinical appeals and validating the accuracy of all received information
-3 years' experience Medicare Part C related to appeals, claims or grievances
-Working knowledge of Medicare Advantage appeal regulations
-Working knowledge of CHS Explanation of Coverage
-Strong written and verbal communication skills
-Proven ability to analyze detailed information
-High School graduate, GED, or equivalent
Click to apply or call 615.316.0753 to express interest and ask questions. We are ready to interview you today!
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