Appeals Specialist Job
Location: Tukwila Washington!
Description: Group Health Cooperative is hiring Appeals Specialist Job right now, this position will be placed in Washington. More details about this position opportunity please give attention to these descriptions. Appeals Specialist-132265 Description Triage and document requests for member appeals, received via phone, fax, email and mail. Research for cases may involve: medical coverage, claims, authorizations, clinical review, eligibility, and interpretation of legal documents. Provide guidance about appeal process and requirements to members, prospective members, providers, other insurance carriers, agents, brokers, attorneys, employer groups and other member representatives over the telephone or via secure email. Answer high volume of complex verbal communication with members and provid! ers interpreting needs in order to assure a clear and accurate! assessment of their issue and assist them in a culturally appropriate manner.
Prepare all material for case review in a way that meets regulatory requirements and the needs of the Appeal Coordinator who will investigate and/or consult on the case. Provide ongoing support to Appeal Coordinator. Education Minimum Some college Preferred Education Vocational School/Certificate Prog Healthcare to include medical terminology, coding, and HIPPA Knowledge/Skills Minimum Knowledge/Skills Requirements Intermediate document handling and data entry; Keyboarding skills while on phone. Microsoft Office products- Word & Excel; Adobe; Intermediate organization and prioritizing skills.
Attention to detail. Intermediate customer service and communication skills on the phone.Can de-escalate difficult calls. Able to clearly translate to documentation what caller is requesting. Able to clearly respond in culturally appropriate manner.
Preferred Knowledge/Skills Advan! ced proficiency with software used by the department. IBM Premier system Lotus Notes Internet and Intranet research Advanced organization and prioritizing skills. Attention to detail. Advanced customer service and communication skills on the phone.
Experience Minimum 3 years Customer Service by phone 2 years working in a medical setting. Preferred Experience 3 years Customer service at Group Health 3 years working in a medical setting related to billing and/or insurance License/Certifications Minimum License/Certifications Requirements None Required Preferred License/Certifications None Required Group Health is an Equal Opportunity Employer committed to a diverse and inclusive workforce. Bargaining unit: WWA Admin NonExempt (non-union) FTE: 1 Days of shift: Monday - Friday Hours of shift: 8am - 5pm
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to Group Health Cooperative.
If y! ou interested on this position just click on the Apply button, you will! be redirected to the official website
This position starts available on: Thu, 09 Jan 2014 14:58:49 GMT