Appeals Specialist

Appeals 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], [Remote]**

**Pay Range**: $20 - $24/hr**

Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

**Requirements**:

- Appeals
- Prior Authorization
- Healthcare Claims
- Medicaid/Medicare

**Position Title: Appeals Specialist**

**Location: Remote**

**Duration: 3+ months of contract with possible extension**

**Shift: Monday - Friday, 8am - 5pm EST**

**Pay Rate: $24.00/hr on W2**

**Need: Appeals, Prior Authorization, Healthcare Claims and Medicaid/Medicare Experience and Knowledge**

**Position Purpose**:
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.

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**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.

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**Required Experience / Skills / Education**:
Knowledge of appeals, disputes, and reconsiderations process.

Medical Office Experience.

Prior Authorization building.

Healthcare Claims.

Medicaid/Medicare/Ambetter knowledge.

Healthcare Background.

Medical Assistant.

Excel, Microsoft.

**Benefits**:
BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

**Keywords**:
[Appeals, Prior Authorization, Healthcare Claims and Medicaid/Medicare]

**About BCforward**:
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

**Employee Type**: Contractor

**Location**: Florida, FL (Onsite)

**Job Type**: Hea