Appeals and Grievances Specialist Temporary Remote Position Job at HealthAxis Group
At HealthAxis Group, LLC
we are seeking a Temporary Appeals and Grievances Specialist to work aproximately 2 months starting as soon as possible and working 4
0 hours per week.
Who we are… At HealthAxis Group, we exist because we believe the US Healthcare System can be better. Our culture of continuous learning, innovation and improvement inspires our team to transform the future of healthcare technology. You can contribute to work that matters with a team that live and work with purpose, care about others, act with integrity, communicate with transparency and enjoy a work-life balance that engages our teammates to give their best every day!
Who you are… At HealthAxis Group you’re more than a “temporary hire” – you’re part of the team… Bring everything that makes you who you are, your unwavering integrity, your imagination and ability to think outside the box along with a healthy disregard for the impossible. Together, we can build greatness for everyone.
Once you work your temporary assignment you will be eligible for priority consideration to return for future seasonal remote hiring periods if you have a 13 week break in service prior to working again. You will also have access to opportunities for regular full-time remote roles when they become available.
HealthAxis’ culture of continuous
learning, innovation, and improvement inspires our team to transform the future of healthcare technology. We are a software development company established in 1965, providing technology and BPO solutions to the healthcare industry throughout the United States. We are a 100% Remote workforce of over 300 passionate, technology driven team members nationwide and growing! Our headquarters is in Tampa, FL.
PURPOSE AND SCOPE:
HealthAxis Appeals & Grievances Specialist role is responsible for reviewing and resolving appeals and grievances in accordance with the standards and requirements established by the Centers for Medicare and Medicaid. The role will ensure compliance with organizational and regulatory requirements for member or provider issues. Quality monitoring and regulatory
risk mitigation.
ESSENTIAL FUNCTIONS:
- Logs, tracks, and processes appeals and grievances.
- Collects the information required by organizational policies and applicable regulations.
- Conducts research and coordination needed to evaluate, process, respond to, and refer or close appeals.
- Work to be quality reviewed by the Sr. Specialist includes but is not limited to verifying the accuracy of appeal data loading, timely processing, and disposition (e.g., using correct appeal/denial letter).
- Conducts general appeal research and filing including but not limited to requesting waivers of liability and/or appointment of representative forms, organizational determination research, requesting member medical records, organizing documentation, preparing written summaries, processing the review of the case, documentation of the appeal resolution and sending completed case files to external review organizations as required by regulatory guidelines.
- Performs special projects as assigned.
- Interacts with other department including Call Center, Claims, and Configuration to resolve member and provider appeals.
EXPERIENCE AND REQUIRED SKILLS:
- Associate degree or equivalent combination of education and work experience.
- 2 years of related experience in a managed healthcare setting, with quality assurance experience preferred.
- Experience in customer/member services or prior authorization within a Medicare or Medicaid is preferred.
- Proficient with MS Office (Word, Excel, PowerPoint, Teams, Outlook, etc.)
COMPETENCIES:
- Work-Under-Pressure. Ability to deal with constraints which are often outside of your control - these might be resource or time constraints, the difficulty of the task or having insufficient knowledge required to complete the task, or unforeseen changes or problems.
- Communications Skills. Ability to convey information and ideas easily and effectively.
- Organizational Skills. A set of techniques used to facilitate the efficiency of future-oriented learning, problem-solving, and task completion.
- Problem Solving Skills. Achieving a goal by overcoming obstacles, a frequent part of most activities.
- Analytical Skills. Ability to deconstruct information into smaller categories to draw conclusions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this position, the employee is frequently required to sit, either in an office environment, or in the context of operating a vehicle. The position is also required to: talk, hear, taste, smell, stand, walk; use hands and fingers to handle, operate, or operate objects, tools, or controls; reach with hands and arms; and occasionally climb and/or balance their body; and stoop, kneel, crouch, crawl. The employee must intermittently lift and/or move objects that weigh approximately 10-25 pounds, and on rare occasions lift and/or move objects that weigh approximately 100 pounds. Duties are performed in environments that are primarily environmentally controlled in an office environment but may range to vehicles, outdoor settings in all weather conditions.
Review and comply with all the relevant Company policies and procedures, local, state, and Federal laws, and regulations. Ensure that employees understand and comply with all-relevant Company policies and procedures, and local, state, and Federal laws and regulations, and establish effective internal systems and controls to promote such compliance.
The duties listed in this job description are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
HealthAxis Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, disability status, or membership in any other group protected by federal, state, or local law.
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