Appeals Representative II

CERIS; Fort Worth (TX); On-site; USD 27,662 - 41,410; Full time

Benefits offered by this job

Medical (HDHP) with Pharmacy

Dental

Vision

401(k)

Paid time off

Job summary

CERIS is hiring an Appeals Representative in Fort Worth, Texas. The role involves reviewing and addressing provider inquiries and appeals while ensuring compliance with relevant regulations.

The successful candidate will have strong attention to detail, excellent communication skills, and a background in healthcare or insurance. A comprehensive benefits package is offered, along with a pay range of $20.08 - $30.06 per hour.

Qualifications

• 1+ years of experience in healthcare, insurance, claim processing, or customer service.
• 1+ years working with customers in a fast‑paced, deadline‑oriented environment.
• 1+ years of experience as an Appeals Representative.
• Strong technical skills with the ability to work across multiple software systems.

Responsibilities

• Review and analyze appeal documentation to determine appropriate actions.
• Set up and initiate appeals process timely.
• Ensure compliance with HIPAA, CMS guidelines, and client instructions.
• Utilize applicable tools and resources to complete setup.

Skills

Knowledge of Medicare, Medicaid, and commercial insurance guidelines

Attention to detail

Time management skills

Organizational skills

Written communication skills

Verbal communication skills

Knowledge of medical terminology

Proficiency with Microsoft applications

Education

High school diploma or equivalent

Job description

Job Description

The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, industry standards, CMS, and state guidelines. This role ensures all appeals are set up accurately and in a timely manner, supporting the appeal process efficiently.

Essential Functions & Responsibilities

• Receiving and analyzing appeal documentation to determine appropriate actions.
• Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents.
• Ensuring compliance with HIPAA, CMS guidelines, and client instructions and policy standards.
• Utilizing applicable tools and resources to complete setup.
• Additional duties as assigned.

Knowledge & Skills

• Knowledge of Medicare, Medicaid, and commercial insurance guidelines.
• Strong attention to detail, time management, and organizational skills.
• Excellent written and verbal communication skills.
• Knowledge of medical terminology and CPT/ICD codes.
• Proficiency with Microsoft applications.

Education & Experience

• High school diploma or equivalent.
• 1+ years of experience in healthcare, insurance, claim processing, or customer service.
• 1+ years working with customers in a fast‑paced, deadline‑oriented environment.
• 1+ years of experience as an Appeals Representative.
• Strong technical skills with the ability to work across multiple software systems and work remotely with self‑management skills.

Pay Range

Pay Range: $20.08 - $30.06 per hour.

Benefits

A comprehensive benefits package is available for full‑time regular employees and includes Medical (HDHP) with Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre‑paid Legal Insurance, Parking and Transit FSA accounts, 401(k), Roth 401(k), and paid time off.

Equal Opportunity Employer

CorVel is an Equal Opportunity Employer, drug‑free workplace, and complies with ADA regulations as applicable.