Appeals Specialist (Part C)

Tmf/C2C • Austin, TX

15h • Remote

About The Position

This position researches and responds to inquiries from providers, suppliers, beneficiaries, health plans, or others involved in the appeals/dispute process. The specialist may conduct phone calls with appellants for the purpose of scheduling phone discussions with the company decision maker. The role requires providing customer service and researching and responding to inquiries received by phone, fax, mail, or email timely and accurately. It involves interpreting requests and determining the appropriate response or course of action to bring to resolution with minimal assistance. Research is conducted using online federal regulations, and contract policy and guidelines are reviewed to complete an accurate and well-supported decision and/or response. The specialist will screen receipts to determine the issue addressed in the correspondence and address it timely, which may involve forwarding cases to the appropriate person or entity. Receipts are logged and entered into a database.

Requirements

• High School Diploma or equivalent
• Three (3) years of general office experience
• 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
• Medicare Part C related appeals activities
• Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)

Nice To Haves

• College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)

Responsibilities

• Provides customer service and researches and responds to inquiries received by phone, fax, mail, or email timely and accurately.
• Interprets requests and determines appropriate response or course of action to bring to resolution with minimal assistance.
• Conducts research using online federal regulations, reviews contract policy and guidelines to complete an accurate and well-supported decision and/or response.
• Screens receipts to determine the issue addressed in the correspondence and address timely which may involve forwarding cases to the appropriate person or entity timely.
• Logs receipts and enters into database.

Benefits

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED