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.

• 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