Appeals Examiner - West Sacramento, CA (On-site)
About The Position
As Appeals Examiner - West Sacramento, CA (On-site), you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.Your role in our mission Review provider appeals using approved guidelines and documents appeal determinations clearly and concisely. Analyze, research and review appeal documentation to ensure all aspects of the appeal have been addressed properly and accurately while maintaining production goals and quality standards. Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation. Maintain performance within defined quality and quantitative objectives. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Requirements
- Total of (2) years or more in medical claims and appeals experience required.
- Experience working with medical insurance and/or medical terminology required.
- Highly proficient with exceptional level of accuracy required.
- Ability to research and verify claim payment issues.
- Knowledge of Microsoft products (Outlook, Word, Excel and TEAMS).
Responsibilities
- Review provider appeals using approved guidelines and documents appeal determinations clearly and concisely.
- Analyze, research and review appeal documentation to ensure all aspects of the appeal have been addressed properly and accurately while maintaining production goals and quality standards.
- Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation.
- Maintain performance within defined quality and quantitative objectives.
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Benefits
- flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
- leadership and technical development academies
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
