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Appeals Representative
2024-05-29
2024-08-18
Employment Type:
Contract
Industry: Professional/Administrative
Job Number: 60053
Office Location: Salem
Job Description
Our Client has an immediate need for an Appeals Representative.
This client works directly with Medical Institutions, distributors, Hospitals and Insurance Companies to provide healing surgical repair wraps for post surgical recovery.
The Appeals Representative position will be 100% Remote and the general hours will be between 8am and 5pm Monday through Friday.
There is a competitive starting hourly pay rate plus a lucrative bonus program on top of that for all employees.
Responsibilities:
Must-Have Skills:
Highly Desired Skills:
This client works directly with Medical Institutions, distributors, Hospitals and Insurance Companies to provide healing surgical repair wraps for post surgical recovery.
The Appeals Representative position will be 100% Remote and the general hours will be between 8am and 5pm Monday through Friday.
There is a competitive starting hourly pay rate plus a lucrative bonus program on top of that for all employees.
Responsibilities:
- Write appeals in which Summary Plan Documents were obtained
- Research SPD and compile necessary supporting documentation for appeals
- Ability to manage, respond or redirect incoming mail to ensure that cases are responded to in a timely fashion.
- Perform research and makes determination of corrective actions and takes appropriate steps to route the account appropriately.
- Route claims to legal and/or external review as required
- Maintain understanding of changing laws and denial codes.
- Develop a thorough understanding of the billing process
- Maintenance of files that contain all of the records and information for each inquiry that would be used as the Administrative record.
- Ability to makes decision, render judgements, take action and assume responsibility for those decisions
- Ability to handle telephone calls from both inside and outside sources with appropriate courtesy and judgment showing a thorough understanding of the issues
- Other responsibilities as required or discovered as position develops.
- Enter relevant information into the Appeals Tracking System
- Deem appeals process exhausted when applicable by submitting required information to insurance companies.
- Respond to all authorization of representation requests/inquiries
- Ability to manage, respond or redirect incoming mail to ensure that cases are responded to in a timely fashion.
Must-Have Skills:
- Exceptional organizational skills and attention to detail and follow through
- Clear understanding and adherence to HIPAA rules and regulations
- Thorough understanding of EOB documents
- Self-motivated achievement oriented team player
- Strong verbal (telephone) and written communication skills
- Ability to maintain composure with confrontational individuals
- Successful performance at training level with consistent performance evaluations of above average demonstrated ability.
Highly Desired Skills:
- Experience with computer systems
- Health insurance industry experience
- Appeals, denial Reconciliation, Collections exposure
- Advanced business writing skills
Job Requirements
Computer Skills, Health Industry Experience, Business Writing Skills, Appeals, Denial Reconciliation, Collections Exposure
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Discover exciting job opportunities in the vibrant Manchester, New Hampshire area! Nestled in the heart of the Granite State, Manchester boasts a thriving job market with plenty of room for career advancement and personal growth. With its picturesque Merrimack River, historic landmarks like the Palace Theatre, Currier Museum of Art, and the Fisher Cats playing at Northeast Delta Dental Stadium, this city offers a unique blend of culture and charm. Explore the local culinary scene, beautiful parks like Livingston Park and McIntyre Ski Area, and take in the breathtaking scenery of nearby Lake Massabesic. Start your career journey in Manchester, NH, and unlock a world of endless possibilities!