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Appeals Specialist Jobs in South Carolina

Appeals Specialist Jobs
By BlueCross BlueShield of South Carolina At Columbia, SC, United States
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.
Appeals Analyst Jobs
By BlueCross BlueShield of South Carolina At South Carolina, United States
Excellent organizational and time management skills.
Continuing education funds for additional certifications and certification renewal
Two years clinical experience plus one year utilization/medical review, quality assurance, or home health, OR three years clinical.
Working knowledge of word processing software.
Strong clinical experience, including home health, rehabilitation, and broad medical surgical experience.
Knowledge of specific criteria/protocol sets and the use of the same.
Specialist, Appeals Jobs
By Experis At Columbia, SC, United States
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.
Appeals Specialist (Medicare Part B) - Palmetto Gba
By BlueCross BlueShield of South Carolina At Columbia, SC, United States
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.
Rn Appeals Analyst (Medicaid)
By BlueCross BlueShield of South Carolina At Columbia, SC, United States
Three years of utilization/medical review, quality assurance, or case management experience plus 5 years clinical nursing experience.
Excellent organizational and time management skills.
This position is full time (40 hours/week) Monday-Friday and will be mainly remote.
Two years clinical experience plus one year utilization/medical review, quality assurance, or home health, OR, 3 years clinical.
Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience.
Working knowledge of word processing software.

Are you looking for a job that will give you the opportunity to make a difference in people's lives? Become an Appeals Specialist and help ensure that individuals and families receive the benefits they need and deserve!

Overview An Appeals Specialist is responsible for providing administrative support to the appeals process. They are responsible for researching and analyzing appeals, preparing and submitting appeals, and providing support to the appeals process. Detailed Job Description An Appeals Specialist is responsible for providing administrative support to the appeals process. This includes researching and analyzing appeals, preparing and submitting appeals, and providing support to the appeals process. The Appeals Specialist is also responsible for ensuring that all appeals are handled in a timely and accurate manner. They must also ensure that all appeals are properly documented and that all necessary information is provided to the appeals committee. Job Skills Required
• Excellent research and analytical skills
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Ability to manage multiple tasks and prioritize workload
• Knowledge of legal and regulatory requirements
• Knowledge of medical terminology
• Proficiency in Microsoft Office Suite
Job Qualifications
• Bachelor’s degree in a related field
• At least two years of experience in a related field
• Knowledge of medical terminology
• Knowledge of legal and regulatory requirements
• Ability to work independently and as part of a team
Job Knowledge
• Knowledge of medical terminology
• Knowledge of legal and regulatory requirements
• Knowledge of appeals process
• Knowledge of medical coding
Job Experience
• At least two years of experience in a related field
• Experience in medical coding
• Experience in appeals process
Job Responsibilities
• Research and analyze appeals
• Prepare and submit appeals
• Provide support to the appeals process
• Ensure that all appeals are handled in a timely and accurate manner
• Ensure that all appeals are properly documented
• Provide necessary information to the appeals committee
• Monitor appeals process and provide updates as needed
• Maintain records of appeals process