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
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