Senior Administrator - Appeals (Remote)

Maximus; Tysons (VA); Remote; USD 27,000 - 39,000; Full time

Job summary

Maximus in Tysons, VA is seeking a qualified professional to serve as a Subject Matter Expert across healthcare process areas. You will analyze data for Independent Medical Review, input information from providers and plans, and respond to client and enrollee inquiries about case status and appeals.

The role requires an associate degree with relevant experience or a HS diploma with more years of experience, strong analytical and communication skills, and the ability to work independently in a

Qualifications

• Associate degree with 2+ years' experience.
• Experience in lieu of an Associate degree (HS Diploma or GED and 4+ years of experience) also considered.
• Proficient in computer usage, including daily operation of web-based applications
• 2 years experience in healthcare, medical office administration, or a related field.

Responsibilities

• Maintain updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position.
• Function as a Subject Matter Expert in one or more process areas.
• Analyze data submitted for Independent Medical Review.
• Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs and health plans to input necessary information into the system.
• Respond to incoming calls from clients, health plans, providers and enrollees regarding case status, questions about the program, and the appeals process.
• Follows established guidelines and directions while maintaining a proactive approach to meeting objectives and deadlines
• Ability to work independently

Skills

Analytical skills

Detail-oriented

Written and verbal communication

Medical terminology

Medical records review

Education

Associate degree

HS Diploma or GED + 4+ years experience

Job description

Essential Duties and Responsibilities:- Maintain updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position- Function as a Subject Matter Expert in one or more process areas.- Analyze data submitted for Independent Medical Review.- Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs and health plans to input necessary information into the system.- Respond to incoming calls from clients, health plans, providers and enrollees regarding case status, questions about the program, and the appeals process.- Follows established guidelines and directions while maintaining a proactive approach to meeting objectives and deadlines- Ability to work independentlyMinimum Requirements- Associate degree with 2+ years' experience.- Experience in lieu of an Associate degree (HS Diploma or GED and 4+ years of experience) also considered.- Proficient in computer usage, including daily operation of web-based applications- 2 years experience in healthcare, medical office administration, or a related field.Preferred Skills- Strong analytical skills- Detail and solution oriented- Excellent written and verbal communication- Knowledge of medical terminology- Experience reviewing and processing medical records or other healthcare documentation with a high degree of accuracy and attention to detail.- Follows established guidelines and directions while maintaining a proactive approach to meeting objectives and deadlinesHome Office Requirements- Maximus provides company-issued computer equipment- Private and secure workspace- Reliable high-speed internet service* Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity* Minimum 5 Mpbs upload speedsEEO StatementMaximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.Pay TransparencyMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.AccommodationsMaximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at [e-mail] .Minimum Salary$24.00Maximum Salary$24.00