[Hiring] Appeals Specialist I @Integrated Resources

Role Description

100% REMOTE. CANDIDATES MUST LIVE IN ONE OF THE PREFERRED 15 STATES (Client, FL, GA, ID, IA, KY, MI, MS, NE, NM, NY (outside greater-NYC), OH, SC, TX, UT, WA (outside greater-Seattle), WI). WILL BE ABLE TO WORK IN THEIR OWN TIMEZONE. SCHEDULE WILL BE MONDAY TO FRIDAY 8AM TO 4:30PM.

• Research member complaints, update system to reflect research completed, and resolve member complaint within the timeframe.
• Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and providers (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid.

Qualifications

• High School Diploma or equivalency.

Requirements

• Min. 2 years operational managed care experience (call center, appeals or claims environment).
• Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria.
• Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials.
• Strong verbal and written communication skills.

Company Description