[Hiring] Appeals Representative III - Team Lead @CERIS

Role Description

The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, and industry standards, along with CMS and state guidelines. This role ensures that all appeals are set up accurately and in a timely manner, supporting the appeal process efficiently. This is a remote position.

Essential Functions & Responsibilities

• Receiving and analyzing appeal documentation to determine appropriate actions
• Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents
• Ensure compliance with HIPAA, CMS guidelines, and client instructions and policy standards
• Utilize applicable tools and resources to complete setup
• Additional duties as assigned

Qualifications

• Knowledge of Medicare, Medicaid, and commercial insurance guidelines
• Strong attention to detail, time management, and organizational skills
• Excellent written and verbal communication skills
• Knowledge of medical terminology and CPT/ICD codes
• Proficiency with Microsoft applications

Requirements

• High school diploma or equivalent
• 1+ years of experience in healthcare, insurance, claim processing, or customer service
• 1+ years working with customers in a fast-paced, deadline-oriented environment
• 1+ years of experience as an Appeals Representative
• Strong technical skills with the ability to work across multiple software systems and work remotely with self-management skills

Benefits

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401 K
• ROTH 401 K
• Paid time off

Company Description

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).