Appeals Specialist II

BC Forward is looking for Appeals Specialist II (Remote)

Position: Appeals Specialist II (Remote)
Location: REMOTE EST
Anticipated Start : ASAP
Duration: 6 months
Job Type: Contract with possible extension
Shift: 8am-5pm EST
Pay-Rate: $24/Hr. on W2

Job Description:
Supports the documentation and processing of appeals, disputes and reconsiderations to ensure they are in accordance with state and National Committee for Quality Assurance (NCQA) requirements. Support the team to ensure appeals, disputes and reconsiderations are reviewed and processed timely.

Meet 50 claim reviews minimum per day.

Required Skills/Experience:
Knowledge of appeals, disputes and reconsiderations process preferred.
Medical Office Experience
Prior Authorization building
Healthcare Claims
Medicaid/Medicare/Ambetter knowledge

Preferred Skills/ Experience:
Knowledge of appeals, disputes and reconsiderations process preferred.
Healthcare Background
Medical Assistant

Software Skills Required: Excel, Microsoft

Education/Experience:
Requires a High School diploma or GED
Requires 1 - 2 years of related experience.

Knowledge of appeals, disputes and reconsiderations process preferred.Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures

Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files

Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up

Conducts research needed to evaluate, process, and respond to appeals, disputes and reconsiderations to ensure a timely decision

Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes and reconsiderations

Gathers appeals, disputes and reconsiderations data to track and report on trends and final outcomes to team including conducting outreach for an update on statuses, determinations, and explanations
Performs other duties as assigned

Complies with all policies and standards

Interested candidates please send resume in Word format Please reference job code 228406 when responding to this ad.

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