About the job
Employer Industry: Healthcare Services
Why Consider This Job Opportunity
- Salary up to $76,032
- Comprehensive benefits package, including various incentive programs and 401k contribution plans
- Opportunity for career advancement and growth within the organization
- Work remotely from within the greater Baltimore metropolitan area with occasional in-office meetings
- Collaborative work environment that encourages feedback and continuous improvement
What To Expect (Job Responsibilities)
- Analyze and prioritize appeals and grievance requests, ensuring accurate entry into the appropriate databases
- Utilize strong written and verbal communication skills to respond to appeals in compliance with State and Federal regulations
- Collaborate with supervisors and team members on unit projects and provide feedback for workflow improvements
- Participate actively in meetings to discuss quality research and problem-solving regarding the appeals/grievance process
- Maintain organization and coordination of files, including purging and transporting inactive files
What Is Required (Qualifications)
- High School Diploma or GED
- Minimum of 3 years of experience in managed care, healthcare, or insurance payer environments
- Strong understanding of medical terminology
- Proven problem-solving and decision-making skills, with the ability to handle multiple customer service demands
- Excellent organizational and analytical skills
How To Stand Out (Preferred Qualifications)
- Previous experience in an appeals and grievance department within a healthcare setting
- College degree
- Familiarity with the employer's system, Member/Provider Service, Claims, or Guiding Care experience
#HealthcareServices #AppealsSpecialist #CareerOpportunity #RemoteWork #CompetitivePay
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