Remote Appeals Specialist: Investigations & Resolution

Devoted Health; United States; Remote; USD 32,000 - 41,000; Full time

Benefits offered by this job

Health insurance

Generous paid time off

$100 monthly mobile or internet stiped

Stock options for all employees

Bonus eligibility for most roles

Parental leave program

401K program

And more….

Job summary

Devoted Health is seeking an Appeals Specialist to join our Appeals Operations and Provider Escalations & Educations teams. You will handle timely processing and informed decision making on appeals from plan providers, non-contracted providers, and members or their representatives.

You will collaborate with Clinical, Medical Directors, UM and claims to ensure accurate reviews. In this role you will communicate with members and providers, coordinate investigations, and document outcomes across

Qualifications

• Strong computer, analytical, oral and written communication skills.
• Bachelor’s degree or equivalent experience in health care, conflict resolution, or related field.
• Detail oriented - the data integrity is very important in this role and all of the documentation that goes with it.

Responsibilities

• Correspond with members and/or providers as required (i.e., written communication and telephone contact along with documentation as appropriate)
• Coordinate with Managers, internal departments and external vendors relative to the investigation, review, and resolution of an appeal and the research needed to prepare the case for internal or external review
• Manage the receipt, investigation, and resolution of appeals in a timely, compliant, and highly effective manner
• Maintain a current knowledge of Devoted Health products, policies and procedures with the ability to relate this information in a clear, concise and understandable manner to members, providers, and other individuals, both internal and external
• Complete data entry and documentation requirements in multiple systems to ensure required CMS universe details are captured appropriately
• Superior investigation, customer service, interpersonal, and problem-solving skills
• Working knowledge of insurance products, policies, procedures, claims process

Skills

Computer skills

Analytical skills

Oral communication

Written communication

Education

Bachelor’s degree or equivalent experience in health care, conflict resolution, or related field

Job description

Devoted Health is seeking an Appeals Specialist to join our Appeals Operations and Provider Escalations & Educations teams. You will handle timely processing and informed decision making on appeals from plan providers, non-contracted providers, and members or their representatives.

You will collaborate with Clinical, Medical Directors, UM and claims to ensure accurate reviews. In this role you will communicate with members and providers, coordinate investigations, and document outcomes across