Appeals Specialist Ii
hace 5 meses
Appeals Specialist II
**BC Forward is looking for **Appeals Specialist II (Remote)**
**Position: Appeals Specialist II (Remote)**
**Location: REMOTE EST**
**Anticipated Start : ASAP**
**Duration: 6 months**
**Job Type: Contract with possible extension**
**Shift: 8am-5pm EST**
**Pay-Rate: $24/Hr. on W2**
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
**Employee Type**: Contractor
**Location**: Florida, FL (Onsite)
**Job Type**: Health Care
**Experience**: Not Specified
**Date Posted**: 08/26/2024
-
Appeals Specialist
hace 4 meses
La Florida, Chile BCforward A tiempo completoAppeals Specialist **BCforward is currently seeking a highly motivated Appeals Specialist for an opportunity in Remote!** **Position Title**:Appeals Specialist** **Location**: Remote** **Anticipated Start Date**: 9/23/2024** **Expected Duration**:3+ Months of contract with possible extension** **Job Type**: [FULL TIME (>%3D30 HRS WEEKLY)], [CONTRACT],...
-
Support Specialist
hace 1 día
La Florida, Chile Global Technology Associates (GTA) A tiempo completoLooking for a Support Specialist (IT)/Service Desk Specialist II **Salary**: $25/hour **What you will be doing as a Support Specialist (IT)/Service Desk Specialist II** - Performs remote servicing and/or repair of company products/services. - Provides technical support to customers on operational or maintenance aspects of system equipment. - Serves as...
-
Authorization Specialist Ii
hace 3 meses
La Florida, Chile BCforward A tiempo completoAuthorization Specialist II **BC Forward is looking for **Authorization Specialist II (Remote)** **Position Title: Authorization Specialist II (Remote)** **Location : REMOTE - FL (EST/CST)** **Anticipated Start Date: 10/23** **Expected Duration: 6 months** **Job Type: Contract with possible extension** **Shift: (Tuesday through Saturday (hours would be...
-
Authorization Specialist Ii
hace 3 meses
La Florida, Chile BCforward A tiempo completoAuthorization Specialist II **BC Forward is looking for **Authorization Specialist II (Remote)** **Position Title: Authorization Specialist II (Remote)** **Location : REMOTE - FL (EST/CST)** **Anticipated Start Date: 10/23** **Expected Duration: 6 months** **Job Type: Contract with possible extension** **Shift: (Tuesday through Saturday (hours would be...
-
Nurse Oncology Specialist
hace 1 mes
La Florida, Chile Vitalassoc A tiempo completoJob SummaryVitalassoc is seeking a highly skilled Nurse Oncology Specialist to join our team. In this role, you will provide direct patient care in support of ADLs, educational, spiritual and psychological support, and pain management & medication administration.About the RoleProvide chemotherapy medications as prescribed within facility policy and...
-
Emergency Department Nurse Specialist
hace 1 mes
La Florida, Chile Vitalassoc A tiempo completoJob Summary:The Emergency Department Nurse Specialist at Vitalassoc plays a critical role in delivering high-quality patient care in a fast-paced environment. As a skilled nurse, you will be responsible for assessing patients' conditions, developing and implementing effective treatment plans, and collaborating with the healthcare team to ensure seamless care...
-
Field Reimbursement Specialist
hace 7 meses
La Florida, Chile Cencora A tiempo completo- What you will be doing Play a vital role in helping patients gain access to life changing therapies! From oral medications to biosimilars to critical cancer treatments to infusions, our associates, with their passion for patients, represent these therapies providing education, coverage, and access solutions to healthcare personnel.Field Reimbursement...
-
Customer Care Transaction Manager
hace 2 semanas
La Florida, Chile Cox Corporate Services A tiempo completoCompany: Cox Automotive - USA Job Family Group: Customer Care Group Job Profile: Customer Care Specialist II Management Level: Individual Contributor Travel %: Yes, 5% of the time Work Shift: Day (United States of America) **Job Description**: As a Transaction Manager, you will: - Provide top-tier account management support for a wide audience of car...
-
Life Insurance Specialist
hace 7 meses
La Florida, Chile AAA The Auto Club Group A tiempo completoIt’s a great time to join AAA The Auto Club Group! JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD **Job Type**: Full time Exempt/Non Exempt: Salary **Job Description**: Reports to (job title): Life Sales Manager I. Position Description Primary Duties and Responsibilities (details of the basic job functions): The Life and Annuity Agent will...
