Appeals Specialist II

at  BCforward

Appeals Specialist II
BC Forward is looking for Appeals Specialist II (Remote)

JOB DESCRIPTION:

Supports the documentation and processing of appeals, disputes and reconsiderations to ensure they are in accordance with state and National Committee for Quality Assurance (NCQA) requirements. Support the team to ensure appeals, disputes and reconsiderations are reviewed and processed timely.
Meet 50 claim reviews minimum per day.
Required Skills/Experience:
Knowledge of appeals, disputes and reconsiderations process preferred.
Medical Office Experience
Prior Authorization building
Healthcare Claims
Medicaid/Medicare/Ambetter knowledge
Preferred Skills/ Experience:
Knowledge of appeals, disputes and reconsiderations process preferred.
Healthcare Background
Medical Assistant
Software Skills Required: Excel, Microsoft
Education/Experience:
Requires a High School diploma or GED
Requires 1 - 2 years of related experience.
Knowledge of appeals, disputes and reconsiderations process preferred.Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures
Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files
Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up
Conducts research needed to evaluate, process, and respond to appeals, disputes and reconsiderations to ensure a timely decision
Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes and reconsiderations
Gathers appeals, disputes and reconsiderations data to track and report on trends and final outcomes to team including conducting outreach for an update on statuses, determinations, and explanations
Performs other duties as assigned
Complies with all policies and standards
Interested candidates please send resume in Word format Please reference job code 228406 when responding to this ad.

EXPERIENCE

Not Specified

Please refer the Job description for details