Appeals Representative

Syndeo

Appeals Representative

Wichita, KS
Paid
  • Responsibilities

    Syndeo Staffing is seeking a qualified Appeals Representative for a temp-to-hire position at a local healthcare company. The hours for this position are Monday - Thursday 8am-5pm and Friday 8am-4pm.

    JOB DESCRIPTION

    Summary:

    An Appeals Representative will review, research and resolve all types of medical claim appeals from members and providers within stringent timeframes.

    Essential Functions:

    • Log each appeal as it is received
    • Prepare acknowledgement and response letters to members and providers
    • Identify, reach, and resolve claim disputes
    • Prepare and submit appeals for Claims Review Committee
    • Review and respond to legal requests
    • Develop and maintain an excellent working knowledge of policies in order to determine eligible benefits and understand how claims were processed or why they were denied
    • Assist providers and members with questions regarding their claims, appeals or policies both in writing and verbally
    • Provide backup coverage for the call center
    • Abide by HIPAA regulations and other privacy policies at all times
    • Maintain an exemplary attendance and tardiness record following established company guidelines
    • Demonstrate ability to work well with other departments and all Medova staff members
    • Complete other tasks, as assigned

    Competencies:

    • Technical Capacity
    • Problem Solving
    • Attention to Detail
    • Initiative

    Required Education and Experience:

    • High School Diploma or equivalent
    • 1 year professional office experience
    • Knowledge of medical terminology and diagnosis and procedure codes

    Preferred Education and Experience:

    • Additional course work in the medical field
    • 2 year health insurance industry knowledge

    Computer Skills:

    • Microsoft Outlook
    • Microsoft Word
    • Microsoft Excel
    • Data Entry
    • Ten Key