Hiring For Grievance & Appeals Coordinator!

100% REMOTE - Texas

Note: Candidates from Texas can only apply!

Candidates who are having 5+yrs of experience in Medical Grievance and Appeals can only apply!

Pay - $20/hr and up

Description:

• Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations.

• analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members, responds to member and provider inquiries (phone, written or walk in), speaking with members, documenting, research, formulating responses in writing to members.

• Inbound member & provider calls for denials, appeals and peer to peer scheduling.

• Initiation of appeals based on call, obtaining necessary information to create appeal event/notes accurately in our systems A lot of research and data entry.

• Working in phone queues daily and must meet service level metrics, adherence, daily productivity.

• Answering denial/appeal related questions from members or providers.

• Member and provider contact.

• Outreach via phone/email

• Very heavy on professional business letter writing

• Research in variety of computer systems

• Lot of cross-functional collaboration with Health plans and Corporate departments

• (Cross Functional meaning Directors and above levels so cannot be intimated)

• Must be able to prioritize quickly

• Cannot be afraid to ask for help and must be comfortable around the team

• Root cause analyses

• Once a case is taken on- must take ownership of that case solely- cannot pass over to another team

• Knowledge of healthcare and/or health insurance

• High-level customer service

• QA

• Utilization management

• Appeals & Grievances

Education/Experience:

Requires a High School diploma or GED preferred Bachelors

Skills:

Prior authorization, 45+ wpm, provider relations, medical terminology, medical record

Top Skills Details:

Prior authorization,45+ wpm,provider relations,medical terminology

Additional Skills & Qualifications:

What previous job titles or background work well in this role?

• Appeals Coordinator / Case Manager

• Medical Biller or Medical Coder

• Claims processor

Experience Level:

High Level

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.