Appeals Representative I

CorVel Career Site•Fort Worth, TX

1d•$17 - $25•Remote

About The Position

The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, and industry standards, along with CMS and state guidelines. This role ensures that all appeals are set up accurately and in a timely manner, supporting the appeal process efficiently. This is a remote position.

Requirements

Knowledge of Medicare, Medicaid, and commercial insurance guidelines
Strong attention to detail, time management, and organizational skills
Excellent written and verbal communication skills
Knowledge of medical terminology and CPT/ICD codes
Proficiency with Microsoft applications
High school diploma or equivalent
1+ years of experience in healthcare, insurance, claim processing, or customer service
1+ years working with customers in a fast-paced, deadline-oriented environment
1+ years of experience as an Appeals Representative
Strong technical skills with the ability to work across multiple software systems and work remotely with self-management skills

Responsibilities

Receiving and analyzing appeal documentation to determine appropriate actions
Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents
Ensure compliance with HIPAA, CMS guidelines, and client instructions and policy standards
Utilize applicable tools and resources to complete setup
Additional duties as assigned