7 Appeals Specialist Jobs in Baltimore, MD

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Appeals Specialist

KMM Technologies

Baltimore, MD | Full Time

$63k-76k (estimate)

3 Weeks Ago

Appeals Specialist

AMPCUS

Baltimore, MD | Contractor

$63k-75k (estimate)

3 Weeks Ago

Medical Appeals Coding Specialist

Johns Hopkins Medicine

Baltimore, MD | Full Time

$72k-90k (estimate)

2 Weeks Ago

Appeals Specialist III-I

Progressive Technology Solutions

Baltimore, MD | Full Time | Contractor

$70k-86k (estimate)

3 Weeks Ago

Appeals Specialist lll-I

Progressive Technology Solutions

Baltimore, MD | Full Time

$68k-81k (estimate)

3 Weeks Ago

Medicaid Appeals Specialist

System One

Baltimore, MD | Contractor

$47k-58k (estimate)

3 Weeks Ago

Senior Appeals Specialist - Remote / Telecommute

Cynet Systems

Baltimore, MD | Contractor

$83k-98k (estimate)

3 Weeks Ago

Appeals Specialist

KMM Technologies Baltimore, MD

$63k-76k (estimate)

Full Time | IT Outsourcing & Consulting 3 Weeks Ago

Save

KMM Technologies is Hiring an Appeals Specialist Near Baltimore, MD

Reach me on Tel: (240) 800-0039 |Email: lax@kmmtechnologies.comPosition: Appeals Specialist IIILocation: Baltimore, MD #REMOTELong Term ContractJob DescriptionMD Medicaid appeal and grievance experience in a managed care environment, data entry skills, organizational skills, medical terminology, and knowledge of systems (Hyland OnBase, Health Rules, Care Manager). The Appeals Specialist III will be responsible for assisting the Manager, Supervisors, and Business Analysts or Operations Coordinators with unit projects, quality audits, and overall operational functions. Responsible for the initial analysis of appeals correspondence, determining next steps, collecting, organizing and tracking information to facilitate and expedite processing of appeals received from a variety of sources. Serves as subject matter expert. Able to provide short term or interim coverage for high level complicated cases that require detailed research and analysis. Determines appropriate action required by prioritizing, researching and analyzing information to successfully complete initial inquiries and be accountable for accurate and timely case entry and assignment. Leads a team in the analysis of existing business processes and systems to identify, document, elevate the presence of risks and trends within systems and processes that may be noncompliant with requirements for proper appeals handling. Analyzes and researches necessary information for high profile cases in a timely or expeditious manner including written responses to governmental agencies. Consistently develops accurate professional written communications and verbal interaction with internal and external stakeholders. Reviews and researches complicated or high profile correspondence with Supervisor as necessary. Will articulately present and discuss compliance as needed and exhibit sound judgement in determining a recommendation or solution to an identified problem. Independently researches contractual benefits, limitations & exclusions and claims related cases as a subject matter expert to assist medical professional staff in performing the review of appeals and reconsiderations. A subject matter expert for internal stakeholders, particularly in specialized appeal areas. Recognizes and acknowledges time sensitive or escalated requests and tasks and acts as a liaison for other departments and company stakeholders to complete Regulatory complaints, internal and external audits and other projects as needed. Provides support and acts as a trainer and mentor to entry level associates including Appeals Specialists I & II. Designs and provides effective training programs for internal customers who need education on the appeals process. Develops and provides information, training and education for appeals associates at Staff, R &T and Nurse Forums. Performs other duties such as committee work and special projects.
QualificationsEducation Level: High School Diploma 5 years' experience in settings such as managed care, health care or insurance payor environment 3 years' experience in Clinical Appeals and Analysis Unit including 2 years' experience as an Appeals Specialist IIPreferred QualificationsCollege Degree Knowledge of CareFirst system, Member/Provider Service, Claims or Care Management experience a plus. Leadership Experience
Thanks & Regards,--
LAXMANKMM Technologies, Inc.CMMI Level 2 | ISO 9001 | ISO 20000 | ISO 27000 Certified
WOSB, SBA 8(A), MDOT MBE & NMSDC MBE
Tel: (240) 800-0039 |Email: lax@kmmtechnologies.com

Job Summary

JOB TYPE

Full Time

INDUSTRY

IT Outsourcing & Consulting

SALARY

$63k-76k (estimate)

POST DATE

07/12/2024

EXPIRATION DATE

08/09/2024

WEBSITE

kmmtechnologies.com

HEADQUARTERS

POTOMAC, MD

SIZE

25 - 50

FOUNDED

2003

CEO

HIMA KOMARAGIRI

REVENUE

$5M - $10M

INDUSTRY

IT Outsourcing & Consulting

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The job skills required for Appeals Specialist include Managed Care, Data Entry, Written Communication, Analysis, Organizational Skills, 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.

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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.

Appeals Specialist

Appeal Resolution Senior Specialist

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Appeals Specialist
AMPCUS
Contractor

$63k-75k (estimate)
3 Weeks Ago

Medical Appeals Coding Specialist
Johns Hopkins Medicine
Full Time

$72k-90k (estimate)
2 Weeks Ago

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