Appeals Resolution Specialist Jobs

Excellent organizational, customer service, and written and verbal communication skills.

Proficiency in spelling, punctuation, and grammar skills.

Perform non-medical reviews and process redetermination letters ensuring timeliness and accuracy.

Prepare unit reports, analyze, and interpret workload, and process issues utilizing various software tools.

Update letters and documents within the department when necessary.

May gather and prepare documentation for legal inquiries and administrative requests.

Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work

3+ years experience in BSA/AML or Fraud related work, preferably in the payments space

Strong investigative skills, including familiarity with public record research and database tools

Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios

Proven working experience as a Compliance Specialist

4+ years relevant experience in BSA/AML and Sanctions related work

Required Education: High School Diploma or equivalent

Required Work Experience: Two (2) years of job related experience (healthcare, insurance, banking or call center).

Our Comprehensive Benefits Package Includes

Eligible for up to a $2400 annual bonus.

Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.

Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools.

Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work

3+ years experience in BSA/AML or Fraud related work, preferably in the payments space

Strong investigative skills, including familiarity with public record research and database tools

Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios

Proven working experience as a Compliance Specialist

4+ years relevant experience in BSA/AML and Sanctions related work

Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work

3+ years experience in BSA/AML or Fraud related work, preferably in the payments space

Strong investigative skills, including familiarity with public record research and database tools

Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios

Proven working experience as a Compliance Specialist

4+ years relevant experience in BSA/AML and Sanctions related work

Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work

3+ years experience in BSA/AML or Fraud related work, preferably in the payments space

Strong investigative skills, including familiarity with public record research and database tools

Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios

Proven working experience as a Compliance Specialist

4+ years relevant experience in BSA/AML and Sanctions related work

Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work

3+ years experience in BSA/AML or Fraud related work, preferably in the payments space

Strong investigative skills, including familiarity with public record research and database tools

Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios

Proven working experience as a Compliance Specialist

4+ years relevant experience in BSA/AML and Sanctions related work

Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work

3+ years experience in BSA/AML or Fraud related work, preferably in the payments space

Strong investigative skills, including familiarity with public record research and database tools

Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios

Proven working experience as a Compliance Specialist

4+ years relevant experience in BSA/AML and Sanctions related work

Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work

3+ years experience in BSA/AML or Fraud related work, preferably in the payments space

Strong investigative skills, including familiarity with public record research and database tools

Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios

Proven working experience as a Compliance Specialist

4+ years relevant experience in BSA/AML and Sanctions related work

Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work

3+ years experience in BSA/AML or Fraud related work, preferably in the payments space

Strong investigative skills, including familiarity with public record research and database tools

Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios

Proven working experience as a Compliance Specialist

4+ years relevant experience in BSA/AML and Sanctions related work

Do you value care management and quality improvement?

Are you an experienced Appeals Specialist looking for a new challenge?

Excellent verbal and written communication skills.

Requires 3+ years’ customer service experience.

Previous experience in the health care industry preferred

Are you motivated, energetic, and excited to become part of the Kepro team?

Previous customer service, appraisal office, or other office experience.

Bilingual in Spanish - (read and speak) is preferred.

Salary Range: $32,000 to $49,653 DOE

Strong organizational skills necessary, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines

Four (4) years of experience within a Medicaid, managed care or healthcare organization.

Substitution of experience for education:

Advanced writing and communication skills

Four (4) years of experience within TennCare

Ability to maintain a high-volume caseload and adhere to the timeliness standard of appeals while conducting the due process review.

Required Education: High School Diploma

Preferred Licensure, Certification & Registration: Medical Billing Certification

-To be eligible, you must be a non-BILH employee or a previous eligible employee who returns to BILH after 1 year.

-Previous employees returning within 1-Year are eligible for a retention bonus.

-Employee must be in good standing to receive the bonus at the time of payment.

-All bonuses are subject to applicable taxes. This program is subject to change at any point

Excellent organizational, customer service, and written and verbal communication skills.

Proficiency in spelling, punctuation, and grammar skills.

50% Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.

30% Prepares unit reports, analyzes, and interprets workload, and processes issues utilizing various software tools.

10% Updates letters and documents within the department when necessary.

10% May gather and prepare documentation for legal inquiries and administrative requests.

Two years of job experience in a related field.

Excellent computer skills with the ability to navigate between multiple software platforms and work on multiple computer screens.

Medical claims processing, appeals, billing, or coding experience.

Our Comprehensive Benefits Package Includes

Work hours during training: 7:30 am to 4:00 pm CT Monday through Friday

Work hours following training: You can start your eight-hour shift between the hours of 5:00 am and 9:00 am CT.

Experience working with Medicare Part B

Prior medical office or insurance experience strongly preferred.

Our Comprehensive Benefits Package Includes

Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.

Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools.

Updates letters and documents within the department when necessary.

Performs other duties and responsibilities as assigned.

Bachelor’s Degree or relevant work experience

On the job training and skills development

Researches, reviews, and resolves reconsideration of previous claim determinations.

Prepares correspondence advising of appeal determination.

Contacts veterinary clinics to secure medical records and discuss difficult cases with clinic staff. Logs and tracks complaints and appeals.