Appeals Team Lead

CorVel Career Site•Fort Worth, TX

7h•$20 - $32•Remote

About The Position

The Appeals Team Lead will be responsible for providing expertise or general support in reviewing, researching, investigating, and resolving all types of appeals and grievances. Corresponds with appropriate parties regarding appeal issues, implications, and appeal determinations. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Answer team questions as needed Monitor and work QC queue Responsible for distribution of appeals Review appeal submission documentation for information/documentation that may affect the review and take action accordingly Review original findings for issues and/or errors Consult with relevant internal parties and seek clarification as necessary Create appeal response that appropriately addresses the issues/questions raised in the appeal Follow all department processes and protocols in completing each step of the appeal process Coordinate special instructions/requests with other internal departments to ensure proper handling of the appeal Maintain a working knowledge of Worker’s Compensation, Medicare, and Medicaid rules, as well as an understanding of CERIS policies Other duties as assigned by supervisor and/or manager KNOWLEDGE & SKILLS: Ability to work well individually and in a team environment Proven strong leadership skills as a performer/leader Knowledge of Medicare (CMS) and Medicaid regulations, regulatory compliance, Managed Care, and medical claims processing guidelines MS Word, Excel and Outlook experience, which extends beyond just their basic functionality (i.e. – pivot tables, conditional formatting, advanced formulas) Familiarity with medical terminology, medical coding, and medical billing regulations EDUCATION & EXPERIENCE: 3+ years in healthcare customer service or insurance collections field Experience working with customer support/client issue resolution management PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $19.62 - $31.56 per hour A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CERIS: CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401 K, ROTH 401 K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

Requirements

Ability to work well individually and in a team environment
Proven strong leadership skills as a performer/leader
Knowledge of Medicare (CMS) and Medicaid regulations, regulatory compliance, Managed Care, and medical claims processing guidelines
MS Word, Excel and Outlook experience, which extends beyond just their basic functionality (i.e. – pivot tables, conditional formatting, advanced formulas)
Familiarity with medical terminology, medical coding, and medical billing regulations
3+ years in healthcare customer service or insurance collections field
Experience working with customer support/client issue resolution management

Responsibilities

Answer team questions as needed
Monitor and work QC queue
Responsible for distribution of appeals
Review appeal submission documentation for information/documentation that may affect the review and take action accordingly
Review original findings for issues and/or errors
Consult with relevant internal parties and seek clarification as necessary
Create appeal response that appropriately addresses the issues/questions raised in the appeal
Follow all department processes and protocols in completing each step of the appeal process
Coordinate special instructions/requests with other internal departments to ensure proper handling of the appeal
Maintain a working knowledge of Worker’s Compensation, Medicare, and Medicaid rules, as well as an understanding of CERIS policies
Other duties as assigned by supervisor and/or manager