Contribute to impactful dispute resolution in a dynamic healthcare environment. Work remotely with flexible hours and collaborative team support. Enhance your skills in appeals management and regulatory compliance.
Appeals Specialist
in Healthcare + Life Sciences ContractJob Detail
Job Description
Overview
- Serve as an Appeals Specialist, managing dispute resolution cases and ensuring compliance with regulations in a remote work environment.
- Handle appeals and claims processes efficiently, adhering to industry standards and organizational policies.
- Collaborate with team members to ensure timely and accurate case management and resolution.
- Utilize systems such as SharePoint, OnBase, and TruCare for case tracking and documentation.
- Prepare appeal packets for external review, ensuring compliance with state and federal regulations.
- Maintain productivity and quality standards while adhering to HIPAA compliance.
- Perform additional duties as assigned, contributing to organizational goals and objectives.
Key Responsibilities & Duties
- Manage the Independent Dispute Resolution (IDR) process, ensuring compliance and timely resolution of payment disputes.
- Prepare, edit, and finalize case files, letters, and summaries for appeals and disputes.
- Ensure accuracy in case documentation, including member demographics and provider details.
- Verify inclusion of required documents and ensure proper setup of cases in the system.
- Submit appeal packets to relevant authorities, maintaining proof of submission and compliance.
- Collaborate effectively with colleagues to achieve successful outcomes and efficient workflow.
- Perform additional duties as assigned, contributing to team and organizational success.
Job Requirements
- High School Diploma or GED from an accredited institution is required.
- Minimum of 2 years of experience in managed care, health insurance, or appeals preferred.
- Proficiency in systems such as SharePoint, OnBase, and TruCare is advantageous.
- Strong critical thinking, decision-making, and communication skills are essential.
- Detail-oriented, able to work under pressure, and meet tight deadlines effectively.
- Knowledge of claims processes and healthcare settings is preferred.
- Ability to maintain productivity and quality standards while adhering to HIPAA compliance.
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