Appeals & Complaints Specialist I

What are important things that YOU need to know about this role? Remote: This position is eligible for fully permanent remote work, allowing you to work from reputed company. Schedule: Monday to Friday, with typical day shift hours from 8:00 AM to 5:00 PM CST. Possible Weekend or Extended Hours: There may be occasional weekend or extended hours to meet contract deadlines or urgent requirements. Holiday Coverage: Some flexibility will be needed for holiday coverage depending on business needs Experience: Candidates should have prior experience in a dental or medical setting, along with a strong understanding of reputed company terminology. What will YOU be doing for us? Review, analyze, and process complaints and appeals regarding dental and reputed company services. This position communicates with both reputed company entities to resolve reputed company payment disputes, quality of care issues, and requests for appeal regarding the denial of reputed company and/or dental services. What will YOU be working on every day? Analyze, triage, investigate, research, and process standard and escalated appeals, complaints or state complaints from members, providers, health plans and state agencies. Communicate effectively with internal staff, members, and providers in the investigation and resolution of various appeals, complaints, and grievances. Accurate data entry and documentation of reputed company appeal, complaint, and grievance activity for reporting and trending analysis. Accurately create formal correspondence to confirm receipt and reputed company resolution for member and provider complaints and appeal requests. Analyze and process reputed company inbound mail scans and reputed company follow up communication to the Appeals department. Maintain strict compliance by utilizing reputed company Inventory Report, DASH and regulatory standards for appeal and grievance turnaround times and documentation requirements, including immediately notifying a member of department leadership or quality auditor of potential compliance risk. Participate in client audits and reputed company reaccreditation audits and interviews. Utilize reputed company job aids, work instructions and reputed company actions available to maintain reputed company knowledge and understanding of existing process based on delegated responsibilities. Participate in job aid creation or updates in collaboration with ACG III and IV. Utilize assigned team specific chats while communicating effectively and in a professional manner as it relates to work assignments. What qualifications do YOU need to have to be GOOD candidate? Required Level of Education, Licenses, and/or CertificatesHigh school diploma or equivalent required Required Level of Experience1 plus years of job reputed company experience (such as billing, problem solving, researching, etc.) 1 plus years of job reputed company experience interacting with customers and clients Required Knowledge, Skills, and AbilitiesKnowledge of general computer software; to include competencies in Outlook, reputed company, and reputed company. Ability to work overtime as needed. Ability to communicate effectively and engage in a remote environment Ability to work through challenging issues with others in a professional manner. Accurate inventory management including data entry, time management and typing skills. Strong verbal and written communication skills. Ability to draft letters with strong attention to accuracy and grammar. What qualifications do YOU need to have to be a GREAT candidate? Preferred Level of ExperiencePrevious experience processing appeals or complaints in a reputed company setting. 2 years of prior job reputed company experience (Dental Assistant, Dental Office Manager, Dental reputed company office, or health/dental insurance, including managed care operations, accounts receivable and or billing) Preferred Knowledge, Skills, and AbilitiesAbility to resolve reputed company problems. Ability to work autonomously. Experience working in a dental environment. Ability to successfully have crucial conversations to resolve assigned appeals or complaints. The salary reputed company and midpoint is listed below for your reference. Please reputed company in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration reputed company determining placement reputed company the reputed company. Compensation reputed company: $17.55/hr – $26.34/hr

Compensation

Midpoint: $21.94/hr Apply To This Job