Review & Appeals Specialist I

NATIONAL COMMISSION ON CERTIFICATION OF PHYS•Johns Creek, GA

6d•$49,000 - $58,240•Hybrid

About The Position

As the Review & Appeals Specialist I, you will work as an integral part of the Review & Appeals team to review disciplinary notifications, exception-to-policy requests, re-establishment requests, and complaints. This role is responsible for ensuring the accuracy and integrity of case data, supporting investigations, and maintaining effective communication with internal and external stakeholders.

Requirements

An associate degree, preferably in Business, Legal Studies, Healthcare, or related field (or equivalent experience).
Working knowledge of Microsoft Office applications, including Word, Outlook, Excel, PowerPoint, and Adobe Acrobat.
Ability to read and interpret organizational policies and job-specific documentation.
Strong analytical and problem-solving skills.
Ability to manage competing priorities and meet established timeframes.
Excellent written and verbal communication skills with strong attention to confidentiality.
Ability to provide exceptional customer service to internal and external stakeholders.
Highly organized with strong attention to detail.
Strong time-management and planning skills.
Strong interpersonal and relationship-building skills that foster collaboration and trust.
Professional judgment and discretion when handling sensitive matters.
A proactive, solutions-oriented mindset.
A collaborative approach and willingness to support team-wide initiatives.
Ability to adapt in a structured, deadline-driven environment.

Nice To Haves

A bachelor’s degree.
Two or more years of professional experience in business, healthcare, appeals and grievances, state medical board, legal, or related field.

Responsibilities

Review incoming disciplinary notifications from internal and external entities, exception-to-policy requests, re-establishment requests, and complaints.
Identify issues requiring additional investigation, validate discrepancies, and ensure appropriate follow-up.
Obtain and organize required documentation for case consideration.
Document case-related information and communications in established databases and systems.
Maintain accuracy and integrity of review and appeals data, correspondence, recommendations, and related applications.
Verify licensure status with relevant state licensing boards.
Analyze documentation and prepare summary findings in accordance with established timeframes and policies.
Correspond professionally with Physician Assistants and internal and external stakeholders.
Refer findings to management or higher-level specialists as appropriate.
Prepare cases for external reporting to FSMB and associated licensing boards.
Maintain working knowledge of NCCPA policies, procedures, operational guidelines, and audit tools.
Build and maintain professional rapport with internal and external partners.
Participate in interdepartmental meetings and complete assigned projects.
Meet departmental accuracy standards and turnaround times for case processing.
Support UAT and other testing activities as needed.