Appeals Representative II

CorVel Brand; Fort Worth (TX); On-site; USD 55,000 - 90,000; Full time

Job summary

CERiS, a division of CorVel Corporation, is seeking an Appeals Representative to handle provider inquiries and appeals via email, fax, telephone, or written correspondence. This is a remote role with strong emphasis on accuracy and timely processing in a compliant environment.

Ideal candidates will have healthcare revenue cycle experience, sharp attention to detail, and the ability to work remotely from home with proficient written and verbal communication skills.

Qualifications

• High school diploma or equivalent required.
• 3+ years of healthcare revenue cycle experience (collections, appeals, denials management, etc) preferred.
• 2+ years working with customers in a fast-paced, deadline-oriented environment.
• 2+ years experience as an Appeals Representative or equivalent role.
• Strong attention to detail, organizational and time management skills.

Responsibilities

• Reviews, analyzes, and completes appeals in accordance with client policy and CMS guidelines.
• Interpret provider appeals and apply analytical thinking to reviews.
• Interpret client policy and CMS guidelines as they relate to CERiS reviews.
• Utilize applicable tools and resources to complete appeals.
• Timely completion of appeals.

Education

High school diploma or equivalent

Tools

Microsoft Office

Job description

The Appeals Representative is responsible for addressing provider inquiries and appeals via email, fax, telephone, or written correspondence ensuring adherence to client policy, industry standards along with CMS and state guidelines as well as client instructions.

This is a remote role.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Reviews, analyzes, and completes appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication
• Ability to appropriately interpret provider appeals and apply analytical thinking skills
• Ability to interpret client policy and CMS guidelines as it relates to reviews done by CERiS such as itemized bill
• Utilize applicable tools and resources to complete appeals
• Timely completion of appeals
• Additional duties as assigned

KNOWLEDGE & SKILLS:

• Prior knowledge of inpatient and outpatient hospital revenue cycle required
• Excellent written and verbal communication skills
• Contract interpretation, medical terminology and coding knowledge
• Proficiency with Microsoft applications

EDUCATION & EXPERIENCE:

• High school diploma or equivalent
• 3+ years of healthcare revenue cycle experience (collections, appeals, denials management, etc)
• 2+ years working with customers in a fast‑paced, deadline‑oriented environment
• 2+ years experience as an Appeals Representative
• Strong attention to detail, organizational and time management skills with the ability to
• interpret, research and identify core issues
• Strong customer focus, analytical and decision making skills
• Strong technical skills with the ability to work across multiple software systems and comfortable work remote out of your home

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CERiS:

CERiS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full‑time regular employees and includes Medical (HDHP) w/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, 401K, ROTH 401K, and paid time off.

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

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.