Medical Appeals Specialist (SCA)

Machinify

5d • Remote

About The Position

The Medical Appeals Specialist performs reconciliation of appeals received from the Provider/MAC, as well as serving as a critical point of contact between the MAC and other internal departments within Performant. As the Medical Appeals Specialist, you will work in a fast-paced and dynamic environment and be part of a multi-location team. The successful candidate will be a team player able to collaborate with a variety of different entities to solve problems and generate solutions.

Requirements

• High School diploma or GED required
• 5+ years in relevant office/administrative/support environment roles with progressive complexity, preferably in healthcare-related business.
• Demonstrated knowledge of healthcare audit, appeals processes, claim processing, billing, and recovery processes and practices (Medicare and Medicaid working knowledge strongly preferred).
• High level of ability in multi-tasking and prioritizing workload.
• Must have flexibility and be able to adapt to ever-changing needs and requirements.
• Intermediate MS Excel and MS Word skills.
• Strong knowledge of medical documentation.
• Able to meet or exceed deadlines.
• Ability to maintain high quality of work while meeting strict deadlines.
• Able to work efficiently, independently, and complete any/all workload as assigned by department management.
• Strong communication in both verbal and written business language skills.
• Courteous, professional, and respectful attitude.
• Responsible, dependable, conscientious, detail-oriented, and reliable.

Responsibilities

• Accurately receive, review, and forward appeal documents and requests, ensuring that all federal and state regulations, contractual compliance, and company guidelines and standards are met.
• Process all appeal documents and requests efficiently and accurately.
• Upload media to accounts and ensure uploads are successful.
• Distribute designated media to other departments as appropriate.
• Meet daily/weekly production standards.
• Provide recommendations to department management on workflow and process improvements towards efficiency, accuracy, and streamlining whenever possible.
• Complete accurately and efficiently all tasks as assigned by department management.
• Perform other incidental and related duties as required and assigned.

Benefits

• Top Medical/Dental/Vision offerings
• FSA/HSA
• Tuition reimbursement
• Competitive salary, 401(k) with company match
• Additional health and wellness benefits and perks
• Flexible and trusting environment where you’ll feel empowered to do your best work

What This Job Offers

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