Easter Seals Jobs

ALTA IT Services is staffing a contract opportunity for a Medicaid Appeals Specialist to support a leading health insurance customer. The Appeals Specialist supports the Provider Appeals Team Lead in the investigation, coordination and resolution of all provider reconsiderations and liens. This role ensures that these issues are resolved within the required timeframes.

Healthcare Appeals Resolution Specialist

Pay rate $28/HR

(100% Remote)

ESSENTIAL FUNCTIONS

• Communicates both verbally and in writing with Providers and other departments, to resolve the provider reconsiderations.

• Generates all correspondence (i.e. acknowledgment and resolution letters) to providers as required to comply with all relevant rules, regulations, and policies.

• Requests, collects and logs all supporting documentation and related data including, but not limited to medical records, prior authorizations, member and/or practitioner/provider statements, claims, medical groups; maintains computer-based records and history of each case for liens.

• Researches paid claims, answers inquiries, and coordinates with other departments, insurance adjustors, attorneys, and members.

• Ensures that letters used comply with required guidelines and timeframes.

  Requirements:

• Required: High school education plus at least 2 years of experience in appeals or related field.

• Abilities/Skills: Must be detail-oriented, have good time management and organizational skills, analytical skills, written and oral communication skills, PC skills

• Knowledge of Microsoft excel and Adobe PDF

• Knowledge of ICD-10 and HCPC codes, XEROX, and eligibility tools

• Having a Laptop/PC

  #M2

System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, TPGS, and MOUNTAIN, LTD., are leaders in delivering workforce solutions and integrated services across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible full-time employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.