Temp - Administrative - Appeals Specialist (Days) Flint MI
Temp - Administrative - Appeals Specialist (Days) Flint MI
Posted on :
23-06-2025
Employer Active
1 Vacancy
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Job Description
Responsible for assisting with coordination of all appeal/grievance activity for the Plan. Responsible for ensuring departmental compliance with applicable regulations and tracking appeal and grievance activity complying with state and regulatory standards. Assists in preparing and researching case files as necessary. Responsible for research and resolution of member and provider claims issues. Responsible for assisting with member and provider education opportunities regarding complaints/grievances/appeals. Identifies process improvement opportunities and develops plans to address opportunities.
Requirement description :
ADDITIONAL LICENSE REQUIREMENTS :
Weekend Requirements : None
On Call Requirements : None
Requirement description :
THIS JOB IS FOR A SPECIFIC CANDIDATE
- This is a 52% markup need. Contractors need to make a facility mandated BR per hour
Please note any travelers living in the following states are ineligible for hire: AK CA CO CT DE HI ID LA MD MA MS MT NE NV NH NJ NM NY ND OK OR PA RI SD UT VT VA WA WY PR - High school diploma or equivalent (GED) - Required
- One year experience in healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology - Required
- Attention to detail excellent grammar skills the ability to multitask and work independently once trained - Required
- Associate degree in business health care or related field - Preferred
- Two (2) years experience and knowledge of HMO PPO TPA PHO and Managed Care functions (e.g. administration medical delivery regulatory compliance claims processing membership/eligibility) - Preferred
- Two (2) years healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology - Preferred
- Work history only
- Please do not include any drivers license or personal documents
ADDITIONAL LICENSE REQUIREMENTS :
Weekend Requirements : None
On Call Requirements : None
Employment Type
Full Time
Key Skills
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