Appeals and Grievance Specialist II
Appeals and Grievance Specialist II
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Job Posted Date: March 31 2025
WHO WE ARE:
AG Globe Services is one of the major providers of clinical and nonclinical healthcare staffing across the United States. We work with Clinicaland NonClinical professionals to be deployed at Long Term Healthcare facilities Hospitals Medical Centers and Behavioral Health Facilities.
MUST HAVE REQUIREMENTS(Applicants will be denied if these requirements are not met)
- Education verification required at time of submission Bachelors Degree
JOB QUALIFICATIONS:
- 5yrs min. healthcare customer service claims denials appeals compliance.
- This position requires the ability to work independently researching and reviewing inquiries from members and providers. Also requires knowledge of benefit interpretation claims reviews CPT and ICD coding.
- Responsible for reviewing classifying researching and resolving member complaints (grievances and/or appeals) and communicating resolution to members or their authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services and TRICARE.
- Coordinates with pertinent departments to effectuate resolution resulting from grievance and appeals resolution decisions made at the plan level or by independent review entities.
- Referral Fee Program: (Please ask our Recruiter for details).
- Healthcare Benefits Plan (Benefit eligibility is dependent on employment status.
- Medical Rx Dental and Vision Benefit Options Available
- Maternity Benefits Option Available
- NO Waiting Period on Medical
- NO Deductibles on Medical
- NO PreExisting Limitations
- Includes both InPatient and OutPatient Benefits
- First Health Network
Required Experience:
Unclear Seniority
Employment Type
Hourly
