Medicare Appeals 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.

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

Thorough knowledge of claims management

Compiles, reviews and analyzes claim files and/or management reports.

Maintains thorough understanding of service and products offered by Medicare Compliance department.

Excellent oral and written communication, including persuasive writing skills

Strong analytical and interpretive skills

Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.

·Strong interpersonal, time management and organizational skills.

·Effective multi-tasking skills in a high-volume environment.

·Excellent written and verbal communication skills.

·Certification as a MSCC, CMSP, CLCP or CNLCP, preferred.

·Understand and apply evidence based medical treatment guidelines, and/or CMS guidelines to future care recommendations.

·Identify and outline Medicare and Non-Medicare covered treatment.

Excellent interpersonal skills and time management

Other duties and responsibilities as assigned

Qualifications:** - High school diploma or equivalent

Previous medical billing experience preferred

Essential Functions:** - Responsible for claim status checks as needed to ensure proper resolution

Initiating contact with insurance providers as needed

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

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Participates in regular member benefits training with health plan, including the member advocate/engagement role.

2 years experience in customer service, consumer advocacy, and/or health care systems.

Experience conducting intake, interviews, and/or research of consumer or provider issues.

Basic understanding of managed healthcare systems and Medicare.

Log all contacts in a database.

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

Income protection benefits: life insurance, Short- and long-term disability programs;

Additional voluntary benefits available; and

The essential functions listed represent the major duties of this role, additional duties may be assigned.

Develop and maintain a Medicare Sales Operations Integrity plan and KPIs that align to CMS marketing and sales related practices

Work closely with sales channel leaders and their teams to collect and share data that strengthens compliant outcomes

Collect, analyze and report on data from various Sales activities to identify potential risk

Experience working in care management systems, such as CCMS, TruCare or Hyland

Prior experience in a Managed Care or Healthcare environment

Demonstrated ability to be detail oriented, work under pressure, manage tight timeframes and exceptional organizational skills.

Manage all duties within regulatory timeframes

Bachelor’s degree from an accredited institution or relevant work experience

Prior knowledge of Medicare and Medicaid health plans

Experience marketing to a culturally diverse target population required

Excellent verbal and written communication skills, including the ability to speak in front of large groups required

Coordinates home nursing assessment visits, when appropriate, to ensure successful enrollment into the program.

Educates VNS Health Plans MA and/or MLTC members on MAP and conducts telephonic enrollments into the product.

Performs retention efforts developed by VNS Health leadership to reduce member turnover.

Educates consumers who contact VNS Health Plans via website about VNS Health Plans Medicare products.