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 position.
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.
Pay Range: $16.36 - $26.31 per hour
