Compliance Appeals Specialist Jobs in Georgia

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.

3+ years people management experience, including coaching and developing compliance specialists/ analysts

Communicate with program management on ongoing technology, and process/workflow change initiatives and ensure appropriate team adoption

Operational knowledge in executing and running a sound Compliance program with hands-on knowledge of MSB regulatory requirements

Understand regulatory landscape and compliance requirements; with emphasis on applicable Compliance and BSA/AML requirements including customer identification, due diligence best practices

Create, monitor, and meet important operational metrics and implement solutions with COM program managers regarding any issues identified

Maintain up-to-date knowledge on BSA/AML regulatory changes and landscape

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

Your highly developed time management skills, systematic approach to organization/planning and keen attention to detail.

Maintain ongoing knowledge regarding NCCPA organizational policies, departmental policies, standard operating procedures, operational guidelines, business rules, reports and audit tools.

Your proven analytical approach and proactive problem-solving skills that identify and recommend solutions to the determined issues.

Your excellent written and verbal communications skills with a proficiency in diplomacy and confidentiality.

Your proven ability to manage competing priorities and accomplishing tasks within the agreed upon timeframe.

At least two years of professional experience in business, healthcare, appeals & grievances, state medical board or legal field.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.