Job Details

OVERVIEW

Our client, a US Fortune 50 organization and a leading provider of Health care and Health Insurance services, seeks Medical Claims/ Appeals Specialist.

** JOB ID:JP00046403

** JOB TITLE: Medical Claims/ Appeals Specialist

** JOB LOCATION: Location: Denison TX

** JOB DURATION: Duration: 4 months+ temp-to-hire!!!

Pay rate: $24.00/hr on W2

Note:

• REMOTE role with possibility
• The schedule for the training period will be a set schedule: 8:00am to 4:30pm EST time.
• The training will be for 5-6 weeks. After training, the candidates may choose to flex the starting time of 6:00 AM EST to 10:00 AM EST.
• If/when they convert temp-hire, they must be willing to work onsite depending on what the HYBRID requirements for FTE associates are at the time of conversion (usually 1-3 days per week).

POSITION SUMMARY:

This entry-level position supports the NGS Appeals Department by reviewing, analyzing, and processing non-complex pre-service and post-service grievances and appeals. These requests may originate from members, providers, regulatory entities, or third parties and involve Medicare Part A and Part B products.

The role focuses on issues related to clinical and non-clinical services, quality of service, and quality of care, including executive and regulatory grievances. Analysts are responsible for researching cases, applying regulatory guidelines, and producing written responses that clearly communicate determinations.

This position does not include utilization review or medical management activities requiring clinical interpretation.

KEY RESPONSIBILITIES:

• Review, analyze, and process non-complex grievances and appeals in accordance with regulatory requirements, accreditation standards, and internal policies.
• Conduct research using department guidelines, claims data, and medical records to evaluate grievance or appeal issues.
• Determine appropriate resolutions or summarize cases for escalation to nursing or medical staff when required.
• Prepare clear, understandable written determinations and response communications.
• Ensure compliance with applicable accreditation and regulatory standards governing grievances and appeals.
• Follow established departmental guidelines and review tools when conducting case analysis.
• Serve as a liaison between the Grievances & Appeals department and other internal teams, including Medical Management, Legal, and Service Operations.
• Maintain accuracy and documentation standards in all case processing activities.

JOB REQUIREMENTS:

• Education: Requires a high school diploma or GED.
• Up to 2 years of experience in one or more of the following areas:
• Grievances and appeals
• Claims processing
• Customer service
• Preferred Skills:Knowledge of medical terminology
• Experience with medical claims processing
• Experience handling appeals or grievance cases
• Familiarity with medical coding
• Strong business writing and letter drafting skills
• Understanding of provider networks and medical management processes
• Familiarity with internal business systems and operational processes.

I'd love to talk to you if you think this position is right up your alley, and assure a prompt communication, whichever direction. If you are looking for rewarding employment and a company that puts its employees first, we'd like to work with you.

Recruiter Name: Lalit Malgotra

Title: Lead Recruiter

Phone: 925-###-####

Company Overview:

Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally: as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients' businesses forward.

Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws.