Appeals Specialist
$51,395–$68,354 year
Hybrid · Rochester, New York, United States or Tarrytown, New York, United States
Job Summary
Review and analyze appeals requests to determine eligibility for appeal; investigate routine and complex appeals; ensure compliance with state/federal regulations (e.g., CMS, Medicaid, NCQA); collaborate with internal/external stakeholders to gather documentation; maintain accurate records and tracking of appeals; monitor status and respond with acknowledgment, extensions, and resolutions; assist enrollees in understanding the appeals process; identify opportunities for process improvement and stay updated on regulatory changes affecting Medicare appeals; contribute to best practices and overall accuracy and timeliness of appeals processing; location noted as hybrid work arrangement across multiple NY sites.
Required Qualifications
- Bachelor’s degree in law, healthcare administration, business or related field required
- Associate’s Degree with minimum 5 years healthcare experience in lieu of Bachelor’s Degree
- Strong attention to detail and ability to manage multiple tasks simultaneously
- Excellent communication skills, both written and verbal
- Exceptional customer service skills and ability to handle difficult situations with empathy and professionalism
- Proficient in using computer systems and software, including Microsoft Office Suite
- Ability to work independently and as part of a team in a fast-paced environment
- Strong organizational and time management skills
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