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Appeals Intake Specialist

A Line Staffing Solutions

Location: Tampa, FL 33634
Type: Full-Time, Non-Remote
Posted on: January 6, 2021
This job is no longer available from the source.
Job Description
Full time Appeals Intake Specialist openings in the Tampa, FL 33634 area with a major healthcare company! Starting ASAP!! Apply now with Jake Z. at A-Line!
JOB SUMMARY:
• Efficiently and accurately conducts the intake of all incoming documents including but not limited to Member and Provider Appeals, as well as re-routing Grievances, Pharmacy, Claims Correspondence, etc., and related requests.
• Determines appropriate classification of each request, performs research and accurate data entry, conducts initial processing and assignment of the requests, as well as generates and mails correspondence in a timely manner.
• Performs duties related to root cause analysis of escalated issues involving member and provider Appeals.
PAY RATE: $16 - $18 hourly
HOURS: 8am-5pm from Mon-Fri
KEY DUTIES AND RESPONSIBILITIES:
• Utilizes multiple systems to gather information, conduct research in different data sources including Xcelys, WC Toolbox, CSE, Care Central, Emma, Appeals/Corr Tracker, assess the situation, and enter data. Needs to access and interpret claim, appeal correspondence and authorization data.
• Perform detailed root cause analysis to determine core issue related to member and/or provider complaint, error or inquiry.
• Serves as a liaison in corresponding and communicating with the mail vendor as needed during the initial review of the appeal request.
• Electronically enters claim and/or authorization detail information in the WCToolbox and Correspondence Tracker systems and documents receipt, disposition and other noteworthy aspects of the cases in the application.
• Evaluates data input and output for accuracy and ensures compliance with data integrity and corporate compliance directives.
• Completes data entry of all enterprise requests in an environment where compliance and accuracy are critical. Ensures timely processing and review of documentation to meet departmental goals and state specific benchmarks for timeliness.
• Performs administrative activities including, but not limited to, generating and mailing acknowledgement and correspondence letters.
WORK EXPERIENCE:
• 1+ year of experience in a Claims, Appeals, Prior Authorization, or health services role, preferably in a health services environment Required.
• Ability to review correspondence and system data to determine appropriate handling consistent with applicable policies and procedures.
• Proficient in data entry; Ability to work across multiple computer programs to process a single request
Why Apply:
• Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
• 401k after 1 year of employment: With employer match and profit sharing
• GREAT Hours! Monday through Friday, 40 hours per week
• Competitive Pay Rate
Keywords: Appeals, Medical Claims, Denials, Prior Authorization, Determination Review, Managed Care, Health Plan, Health Insurance, Utilization Review, Utilization Management, STARS, HEDIS, NCQA, URAC, CMS, Medicare, Medicaid, HMO, Quality Assurance, Quality Improvement
Job Requirements
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* 1+ year of experience in a Claims, Appeals, Prior Authorization, or health services role, preferably in a health services environment Required. * Ability to review correspondence and system data to determine appropriate handling consistent with applicable policies and procedures. * Proficient in data entry; Ability to work across multiple computer programs to process a single request At least 1 year experience. $16-$18 per HOUR Employment Type: Full-Time