Sorry, this listing is no longer accepting applications. Don’t worry, we have more awesome opportunities and internships for you.

Medical Appeals Specialist

Med National Staffing Inc.

Medical Appeals Specialist

Los Angeles, CA
Full Time
Paid
  • Responsibilities

    Job Description

    MedNational is seeking candidates with experience in eligibility/enrollment and benefits, as well as experience with Member and/or Provider Appeals and Grievances.

    Position will start remote, however will transition to an onsite position once offices reopen in 2021. Candidate must be located in LA/OC area to qualify for the position.

    ESSENTIAL FUNCTIONS: • Resolves and prepares written response to incoming member or provider appeals, grievances, complaints and/or disputes. • Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error. • Identifies potential provider problems through a proactive approach in which data is mined and trended to identify and prevent provider problem areas. • Uses a variety of references to research and prepare healthcare provider information for loading into the health plan system/database; enters provider demographics, contract affiliation, or other data as needed. • Interfaces with other departments regarding questions about provider configuration or other relevant provider issues. • Composes all correspondence and appeal information concisely and accurately, in accordance with regulatory requirements. • Maintains tracking system of correspondence and outcomes; maintains well-organized, accurate and complete files for all appeals, grievances, complaints and/or disputes. • Monitors each request to ensure all internal and regulatory timelines are met.

    REQUIRED EDUCATION: High School diploma or GED equivalent

    REQUIRED EXPERIENCE: 2-3 years experience in a managed care setting; CPT and ICD-9 coding, data entry, and 10-Key experience. 2-3 years managed care experience; claims review and processing background including coordination of benefits, subrogation, and eligibility criteria.

    Company Description

    Using the best business practices obtained from many years of experience in Business, Law, and Recruiting and Staffing, the Founders at CrossFire Group (“CrossFire”) started in downtown Royal Oak, MI more than a decade ago. With backgrounds in Information Technology (IT) and the Legal Industry, CrossFire began placing by IT and Legal Professionals in contract and direct-hire positions throughout the Midwest. Since our founding, CrossFire has grown into a full-service Human Capital Solutions Organization. We are proud of now providing full services beyond recruiting and staffing. Our portfolio of services includes HR supply chain management, human resources consulting, and many customized Human Resource related services.