16 Jobs in Phoenix, AZ
Icon Consultants is Hiring an Appeals Specialist Near Phoenix, AZ
Knowledge/Skills/Abilities" Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Molina members, providers and related outside agencies to ensure that internal and/or regulatory timelines are met.
" Research claims appeals and grievances using support systems to determine appeal and grievance outcomes.
" Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines.
" Responsible for meeting production standards set by the department.
" Apply contract language, benefits, and review of covered services
" Responsible for contacting the member/provider through written and verbal communication.
" Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested.
" Composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements.
" Research claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
" Resolves and prepares written response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments or to requests from outside agencies
Job QualificationsREQUIRED EDUCATION:
High School Diploma or equivalency
Required Experience" Min. 2 years operational managed care experience (call center, appeals or claims environment).
" Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria.
" Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials.
" Strong verbal and written communication skills
Job Summary
Contractor
Business Services
$47k-57k (estimate)
05/24/2024
06/21/2024
ICONConsultants.com
HOUSTON, TX
500 - 1,000
1998
Private
PAMELA A CHAMBERS O ROURKE
$200M - $500M
Business Services
Related Companies
About Icon Consultants
ICON Information Consultants offers a portfolio of consulting and professional services.
The job skills required for Appeals Specialist include Managed Care, Written Communication, Claim Processing, Call Center, etc. Having related job skills and expertise will give you an advantage when applying to be an Appeals Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Appeals Specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Appeals Specialist positions, which can be used as a reference in future career path planning. As an Appeals Specialist, it can be promoted into senior positions as an Appeal Resolution Senior Specialist that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Appeals Specialist. You can explore the career advancement for an Appeals Specialist below and select your interested title to get hiring information.
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