BusinessOperations - Appeals Specialist II - J00909

Mindlance; Brackettville (TX); Remote; USD 35,000 - 45,000; Full time

Job summary

A healthcare services provider in Brackettville, Texas, is seeking support for appeals documentation and processing. This role requires a high school diploma and familiarity with appeals processes. Responsibilities include data entry and research tasks supportive of regulatory compliance. Candidates should have strong organizational skills for remote work. Regular hours available with no overtime.

Qualifications

• 1 – 2 years of related experience preferred.
• Strong organizational and communication skills needed.

Responsibilities

• Support the documentation of appeals and claims processing.
• Perform data entry and maintain documentation files.
• Conduct research for evaluating and processing appeals.

Skills

Knowledge of appeals processes

Data entry skills

Education

High School diploma or GED

Job description

Overview

Position Purpose: Supports the documentation and processing of appeals, disputes and reconsiderations to ensure they are in accordance with state and National Committee for Quality Assurance (NCQA) requirements. Support the team to ensure appeals, disputes and reconsiderations are reviewed and processed timely.

Education and Experience

• Requires a High School diploma or GED.
• Requires 1 – 2 years of related experience.
• Knowledge of appeals, disputes and reconsiderations process preferred.

Responsibilities

• 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.
• Complies with all policies and standards.

Equal Employment Opportunity

EEO: “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”

Typical Day, Work Schedule and Environment

• M–F schedule options: 7:00am–3:30pm (CST) / 8:00am–4:30pm (EST) with 30 minute lunch; or 7:00am–4:00pm (CST) / 8:00am–5:00pm (EST) with 1 hour lunch.
• No overtime will be available.
• Remote work with virtual assistance; Teams/Camera/Huddles and 1:1 with Leadership.