Job description
SELECT SOURCE INTERNATIONAL
Select Source International (SSI) has been serving major corporations for more than 15 years. At SSI, we believe in building a corporation with only the strongest and most capable individuals. Our world-class consultants have the expertise to meet our clients’ demands. Here at SSI, we pride ourselves on the fundamental belief that our team is essential to our company's growth. We assist our consultants every step of the way in order to match them to the best possible position for their skills.
Job Title: Appeals and Grievance Coordinator
Location: Durham, NC (Remote option available)
Duration: 6 Months
Job Description
Responsible for the analysis, research and completion of standard appeals and grievances.
Will address all customer concerns and ensure timely and complete resolution and satisfaction.
Identify, collect, and analyze appropriate documentation from multiple internal systems including claims, customer contract management, benefit booklets, UM systems, coding claim edits, etc. and external sources including pharmaceutical companies, attorneys, providers, Medicare, PBMs, etc.
Consult and confer with medical directors and other clinical staff to ensure the appropriate decision has been made and the approved outcomes are implemented.
Review, analyze and make determinations on provider requests for increased payments related to coding and/or bundling issues.
Initiate claim adjustments on individual cases when necessary and follow and track until completion.
Identify and take corrective action on appeals or grievances that result from noncompliance of contract provisions, appeal or grievance guidelines, provider contract violations and/or medical policies.
Stays current with press releases, emails, and other forms of communications relaying initiatives, contracting issues, as well as Plan wide concerns.
Demonstrates high degree of appropriate knowledge of all areas of the plan.
Identify and create action plans to educate internal departments on benefit misinterpretation and/or claim payment system errors.
Answer member/provider questions via incoming telephone calls in a professional quality driven manner.
Hiring Requirements
Associate's degree and 6 months - 1 year claims, customer service, medical office (billing, authorizations and/or patient accounting etc.), health insurance or coding experience
If no degree, High School Diploma and 1-3 years’ claims, customer service, medical office (billing, authorizations and/or patient accounting etc.), health insurance or coding experience 6 months experience in claims, Healthcare Management and Operations, and/or customer service.
Nice to have: Facets experience - Medicare CTM Experience - or Appeals and grievance experience - someone familiar with claims and healthcare, troubleshooting minor computer issues.
Best Regards,
Deepak Singh Tomar
Cell: 612-474-9508
Deepakt(at)selectsourceintl(dot)com
13911 Ridgedale Drive Suite 230 Minnetonka, Minnesota 55305
Disclaimer: Select Source International (SSI) does not tolerate discrimination against any applicant on the basis of gender, sexual orientation, race, religion, national origin, ethnicity, veteran status, disability, age, sexual preference or any other protected status designated by federal, state or local law. It is SSI’s policy to affirmatively recruit, hire, train, assign, transfer, evaluate, compensate, provide benefits, promote, demote, layoff, recall, and terminate employees on their own abilities, achievements and experiences. This policy applies to all SSI employee activities. SSI encourages diversity in hiring, recognizing that this enriches the work environment for all SSI associates and that a broad variety of perspectives enhances decision-making and creativity.
SSI is an Equal Opportunity Employer.
Job Type: Contract
Pay: $25.00 - $28.00 per hour
Schedule:
- 8 hour shift
- Monday to Friday
Education:
- High school or equivalent (Preferred)
Experience:
- Appeals and Grievance: 2 years (Preferred)
- Medical claims: 2 years (Preferred)
- Facets: 1 year (Preferred)
- Medicare CTM: 1 year (Preferred)
Work Location: One location
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