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Health Care Appeals Specialist

Location : Remote
Job Type : Contract
Reference Code : 14459
Hours : Full Time
Travel : No
Relocation : No
Job Category : Healthcare - LPNs & LVNs

Job Description :

We are looking for a a LVN or LPN to work as a Appeals Specialist for one of our large insurance Clients.


Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing.
Candidate can be located anywhere within the US.
Must have Microsoft office experience. Preferred Medicare Advantage appeals and or grievance experience.
Responsibilities included processing Medicare Advantage grievances in accordance with CMS guidelines.


Overview


Day to day responsibilities of the Appeals Specialist include (but are not limited to):



  • Manage submission, intervention and resolution of appeals, grievances, complaints and/or disputes from members or providers and related outside agencies

  • Conduct pertinent research, evaluate, respond and complete appeals, grievances, complaints and/or disputes and other inquiries accurately, timely and in accordance with all established regulatory guidelines

  • Prepare appeal summaries and correspondence and documents information for tracking/trending data

  • Additional tasks as assigned


Required Qualifications :

Qualifications



  • 2-4 years of Utilization Review experience and Managed Care experience

  • Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing.

  • Familiarity with Medicaid and Medicare claims denials and appeals processing,


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