Appeals Specialist II

Appeals Specialist II

BCforward is currently seeking a highly motivated Appeals Specialist II for an opportunity in Remote (EST)!

Position Title: [Appeals Specialist II]

Location: [Remote (EST)]

Anticipated Start Date: [ASAP]

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Expected Duration: [6 Months Contract]

Job Type: [FULL TIME (>=30 HRS WEEKLY)/PART TIME (<30 HRS WEEKLY)], [CONTRACT/TEMP TO HIRE/PERM], [REMOTE/HYBRID/ON-SITE]

Pay Range: [$20] - [$24]

Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

Requirements:

• Knowledge of the appeals, disputes, and reconsiderations process.
• Prior Authorization experience.
• Healthcare claims experience.
• Medical office experience

Job Description:

Position Purpose:
The Appeal Specialist II supports the documentation and processing of appeals, disputes, and reconsiderations to ensure compliance with state and National Committee for Quality Assurance (NCQA) requirements. The role is focused on timely and accurate processing and review of appeals, disputes, and reconsiderations in line with regulatory and accreditation guidelines.

Education/Experience Requirements:

• High School diploma or GED required.
• 1-2 years of related experience required.
• Knowledge of appeals, disputes, and reconsiderations processes is preferred.

Key Responsibilities:

• Documentation & Processing: Perform data entry to support the tracking, logging, and processing of appeals, disputes, and reconsiderations according to regulatory and NCQA standards.
• Prepare Correspondence: Draft and maintain communication related to appeals, disputes, and reconsiderations and ensure documentation files are up to date.
• Investigate & Review: Review and investigate appeals, disputes, and reconsiderations requests to determine necessary follow-up actions and gather data for case evaluation.
• Conduct Research: Perform research to assess, process, and provide responses to appeals, disputes, and reconsiderations in a timely manner.
• Case File Preparation: Prepare detailed case files, including supporting documentation, for reviews, processes, and reporting of appeals, disputes, and reconsiderations.
• Data Tracking & Reporting: Gather and analyze data related to appeals, disputes, and reconsiderations to track trends, final outcomes, and communicate findings with the team.
• Other Duties: Perform other duties as assigned and comply with company policies and standards.

Performance Expectations:

• Meet a minimum of 50 claim reviews per day.

Required Skills/Experience:

• Knowledge of the appeals, disputes, and reconsiderations process.
• Prior Authorization experience.
• Healthcare claims experience.
• Medical office experience.

Preferred Skills/Experience:

• Healthcare background.
• Medical Assistant experience.
• Medicare/Ambetter knowledge.

Benefits:

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

Keywords:

[KEYWORDS FOR SEO OPTIMIZATION]

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 236624 when responding to this ad.

---

Salary : $20 - $24