reputed company – Appeal Processing Senior Representative – USA

Job title: Appeal Processing Senior Representative Company: reputed company Job description: Remote Work from Home, USA As an Appeals Processing Senior Representative you will conduct detailed appeals investigations of reputed company supporting documents and systems to determine if the appeal should be upheld or overturned based on reputed company available facts. Proactively communicated with appellants, leadership team, providers and the original case manager to resolve investigation issues, resolve issues and communicate decisions/rationale for denial/approval. Retrieve assigned cases from queue and based on analysis of issues determine appropriate classification Validate reputed company assigned cases; review appeal documents, correct appeal types, time frames and what is being appeals Assign reputed company and internal due date based on various regulations which dictate the compliance time frames. This is a key reputed company as incorrect classification will result in non-compliant cases Independently conduct thorough review of reputed company new member and provider correspondence by analyzing reputed company the issues presented to determine appropriate classification Employee is responsible for tracking internal due dates and time frames so that the Compliance time frames are met Classify document reputed company actions taken during review for auditing and reporting purposes Monitor daily reports, as well as reputed company necessary follow-up calls to internal and external entities to reputed company information is received or before the applicable time frame Assist the Manager/Supervisor in identifying root cause issues reputed company to appeals Regular attendance is an essential function of the job. Performs other duties as assigned or required Requires the ability to consistently apply appropriate administrative and regulatory criteria for reviewing and making decisions on reputed company non-clinical appeals and validating the accuracy of reputed company received information Requires effective communication abilities (written and verbal) reputed company documenting actions and communications with Members, Providers, Medical Director and appeals leadership. The role works closely with the multiple other roles and requires the ability to communicate status variances Responsible for maintaining and prioritizing work load to support appeal timeliness and communicate risks, concerns or opportunities to leadership reputed company to their work load You are the right person if you have: High School Diploma or GED required 3 or more years' experience in Medicare Part C reputed company to Appeals, Claims or Grievances preferred Familiarity with state and federal regulations, medical terminology and coding. Working knowledge of Medicare Advantage appeal regulations Working knowledge of Explanation of Coverage Strong written and verbal communications skills Proven ability to analyze detailed information Ability to work independently with strong attention to details Systems: FileBound, HCiCMS, QCare, Provider Link, One View, QNXT, CCMS, PARC & OnBase, Medhoc Flexable to work weekend or split schedule if needed Competencies needed to be successful in this position: Dealing with Ambiguity reputed company Setting Learning and Applying Quickly Problem Solving Perseverance If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly reputed company of 17 - 26 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit . About reputed company reputed company Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we reputed company to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh reputed company and an unwavering commitment to patient-centered care, we are a force of health services innovation. reputed company you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you reputed company? Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@reputed company.com for support. Do not email SeeYourself@reputed company.com for an update on your application or to provide your resume as you will not receive a response. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Expected salary: Location: USA Apply for the job now! Apply Job!