Appeals Specialist II

Randstad is seeking a professional healthcare candidate with experience in the below.  To verify if prior authorization was required for the services rendered. •                To verify if an authorization is on file, and if said authorization was built correctly per the Auth Guidelines and loaded to Amisys with applicable information (dates of service, units, procedure code, provider, etc.). •                To review the attachments for extenuating circumstances, market specific nuances, service specific nuances, and/or provider specific nuances. •                To verify medical records are present for claims needing medical necessity review.  

salary: $22.99 - $23 per hour
shift: First
work hours: 9 AM - 6 PM
education: High School

Responsibilities

Knowledge of appeals, disputes and reconsiderations process preferred.

Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures

Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files

Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up

Conducts research needed to evaluate, process, and respond to appeals, disputes and reconsiderations to ensure a timely decision

Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes and reconsiderations

Gathers appeals, disputes and reconsiderations data to track and report on trends and final outcomes to team including conducting outreach for an update on statuses, determinations, and explanations
Performs other duties as assigned
 




Skills

Basic Software SkillsResponsivenessAnalytical Thinking
QualificationsYears of experience: 2 yearsExperience level: Experienced
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.


Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

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