Contribute to impactful healthcare operations in a remote contract role. Enhance your expertise in managed care and appeals processes. Collaborate with a dedicated team to achieve regulatory compliance.
Appeals Specialist
in Healthcare + Life Sciences ContractJob Detail
Job Description
Overview
- Work remotely as an Appeals Specialist in a contract role, supporting managed care and health insurance operations.
- Utilize your administrative and clerical expertise to ensure compliance with regulatory standards.
- Collaborate with team members to manage appeals and dispute resolution processes effectively.
- Leverage your knowledge of claims and tracking systems to maintain accurate case management.
- Contribute to the preparation and submission of appeal packets for external review.
- Ensure adherence to company policies and regulatory requirements in all tasks.
- Support organizational goals by maintaining productivity and quality standards.
- Assist with additional duties as assigned, contributing to team success.
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.
- Monitor submissions and timelines to maintain regulatory adherence.
- Collaborate effectively with colleagues to ensure efficient workflow and successful outcomes.
- Maintain accuracy in case management systems, including OnBase and TruCare.
- Ensure proper documentation and compliance with HIPAA standards.
- Submit appeal packets to external entities within required timeframes.
- Assist with intake processes for dispute resolution cases as needed.
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 with systems such as SharePoint, OnBase, TruCare, or Hyland.
- Strong critical thinking, decision-making, and communication skills are essential.
- Detail-oriented with the ability to work under pressure and meet deadlines.
- Knowledge of claims processes and healthcare settings is advantageous.
- Ability to maintain productivity, quality standards, and regulatory compliance.
- Experience in customer service or administrative roles is beneficial.
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