Appeals Specialist
Remote · Austin, Texas, United States or US
Job Summary
Appeals Specialist responsible for researching and responding to inquiries from providers, suppliers, beneficiaries, health plans, or others involved in the appeals/dispute process. Duties include handling inquiries by phone, fax, mail, or email; interpreting requests to determine appropriate action; conducting research using federal regulations and contract policies to prepare accurate, well-supported decisions; screening receipts to determine issues; forwarding cases as needed; logging receipts and entering data into the database. Requires strong customer service, documentation, and communication skills, with experience in healthcare/Medicare-related contexts and the ability to work independently within defined guidelines.
Required Qualifications
- High School Diploma or equivalent
- Three (3) years of general office experience
- College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis
- One (1) year of Medicare Qualified Independent Contractor appeals OR One (1) year of professional business writing experience in the healthcare, customer service or legal industries
- Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)
- License/credentials reimbursement (benefits) are offered in the package
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