Employer Industry: Healthcare Services

Why consider this job opportunity:
- Competitive compensation package with benefits
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on member and provider satisfaction
- Work in a regulated environment that adheres to state and federal guidelines

What to Expect (Job Responsibilities):
- Review and resolve member and provider complaints in accordance with established standards
- Conduct comprehensive research on appeals, disputes, grievances, and complaints to ensure timely resolutions
- Request and review medical records and detailed bills to determine appropriate responses
- Prepare appeal summaries and correspondence, ensuring compliance with regulatory requirements
- Resolve provider reconsideration requests related to claims payment and adjustments

What is Required (Qualifications):
- High School Diploma or equivalent
- Minimum 2 years of operational managed care experience in a call center, appeals, or claims environment
- Background in health claims processing, including coordination of benefits and eligibility criteria
- Familiarity with Medicaid and Medicare claims denials and appeals processing
- Strong verbal and written communication skills

How to Stand Out (Preferred Qualifications):
- Experience with regulatory guidelines for appeals and denials
- Knowledge of provider contracts and fee schedules

#HealthcareServices #MemberSatisfaction #CareerGrowth #ClaimsProcessing #EqualOpportunityEmployer

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