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Provider Appeals Specialist

Phoenix, AZ

Provider Appeals Specialist
Phoenix AZ
Contract
Remote

The hours would be 8 am to 4:30 PM EST M-F.

Basic qualifications for the role are: 1 Year of medical claims processing experience(Must be with a healthcare plan, not on behalf of provider or provider’s office), Medicaid insurance customer service or claims processing, knowledge/navigation skills for Microsoft programs in fast paced, production driven environment and dedication to attendance adherence. Training will be provided by client-Absences will not be permitted during training-about 4 weeks. 
 
Candidate will also have the desire to further their abilities and knowledge of Medicaid medical insurance processes as they will be responsible for the research and resolution of Medicaid provider appeals that will involve research of member benefits, eligibility, provider contracts, billing and coding, Utilization Management and state Medicaid policies.
 
Additional qualifications desired, but not necessary are:
 
•         Medicaid/Medicare Insurance Customer Service with managed care plans or directly with CMS
•         Billing and Coding-Medical Insurance 
•         Strong written and verbal communication skills
•         Self-resolved troubleshooting ability for various IT issues
•         Knowledge of Member/Provider Appeals and Grievances, processes, resolutions, compliance TAT
•         Sense of urgency with production and responsiveness to email and MS Teams 
•         Quality Driven
•         Knowledge of QNXT
•         Knowledge of PEGA
•         Knowledge of SharePoint
•         Ability to create and fax written communication in a professional manner including spelling and grammar. 

Thanks,
Sweta N
Sr. Technical Recruiter
Reqroute Inc,
Email: Sweta@reqroute.com
Phone: 408-600-2007 Extn: 1015
 
Companies across U.S. have engaged ReqRoute, Inc to deliver skilled, dedicated IT professionals. Recruiting is our passion and we support Fortune 1000 companies with their hiring needs. We always seek to deliver competitive and sought-after career opportunities to our potential consultants and employees. We invite you to review the position requirements and apply today if your skills match our needs.  
 
ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law. (www.reqroute.com)

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