Provider Appeals Analyst
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.