Appeals Specialist III Job at Three Point Solutions, Baltimore, MD

TDdENGtpeThFZWVRc2VhK2xFaVFaaVhmVHc9PQ==
  • Three Point Solutions
  • Baltimore, MD

Job Description

Job Title: Appeals Specialist III / Member Service Rep III Client: Health Care Insurance Duration: 4 Months Location: Baltimore, MD 21224 (Mandatory- 100% remote however the resource must reside in District of Columbia, Maryland, Virginia(DMV) Job Title: Appeals Specialist III Responsibilities: Assist Manager, Supervisors, and Business Analysts with projects, quality audits, and operations Analyze appeals correspondence, determine next steps, and expedite processing Serve as subject matter expert, providing coverage for complex cases Prioritize, research, and analyze information for initial inquiries Lead a team in identifying risks and trends in processes Research high-profile cases and communicate with governmental agencies Develop accurate professional written communications and verbal interactions Present and discuss compliance issues, providing recommendations Research contractual benefits, limitations, and exclusions Assist medical staff with appeals and reconsiderations Act as liaison for time-sensitive or escalated tasks Provide training and mentorship to entry-level associates Design and deliver training programs for internal customers Support committees and special projects Top 5 Required Skills: MD Medicaid appeal and grievance experience in managed care Data entry skills Organizational skills Medical terminology Knowledge of systems (Hyland OnBase, Health Rules, Care Manager) Qualifications: Education Level: High School Diploma Experience: 5 years in managed care, health care, or insurance payor environment 3 years in Clinical Appeals and Analysis Unit 2 years as Appeals Specialist II Preferred Qualifications: College Degree Knowledge of client systems, Member/Provider Service, Claims, or Care Management Leadership experience #ZR Three Point Solutions

Job Tags

Remote job,

Similar Jobs

Routable, Inc

Manager, ABM Sales Development Job at Routable, Inc

 ...As Manager, ABM Sales Development, you will lead and develop a team of Sales Development Representatives who are responsible for identifying, qualifying, and generating new business opportunities in order to achieve revenue targets. An integral part of the Go-to-Market... 

aci environmental consulting

Environmental Scientist Job at aci environmental consulting

 ...Company Description aci environmental consulting is an environmental consulting firm with offices in Austin, Texas (Headquarters) and...  ...Natural Resources Management, or Environmental Science. This is an entry-level position, however any previous experience in environmental... 

Dev10

Dev10 | Dev10 Entry Level Software Developer WI Job at Dev10

 ...those who want to break into the technology industry as a Software Developer but lack the skills or experience to get there on their own...  ...takes college graduates with the passion and aptitude to be entry-level software developers and provides hands-on training and client... 

AmeriGas

Tanker Truck Driver - CDL and Hazmat Job at AmeriGas

 ...and overtime Requirements All Delivery Representatives should have a valid class A or B CDL. Must be willing to obtain hazmat and tanker endorsements; reimbursements provided Acceptable driving record Satisfactory completion of a DOT physical, drug test and background... 

Optum

Physician, Primary Care Pathways Program, Oregon Job at Optum

 ...Optum OR is seeking a Primary Care Pathway Physician to join our team remotely in Oregon. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, youll be an integral part of our...