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