This is a remote position open to any qualified applicant that lives in the United States.
Summary:
We are seeking a dedicated Provider Appeals & Grievance Specialist with1 to 2 years of experience to join our team. The ideal candidate will have strong technical skills in MS Excel, knowledge/navigation skills for Microsoft programs in fast paced, production driven environment and dedication to attendance adherence. Absences will not be permitted during training-approximately 6 weeks. This is a work-from-home position with day hours, and no travel is required.
Candidate will also have the desire to further their abilities and knowledge of Medicaid medical insurance processes as they will be responsible for the research and resolution of Medicaid provider appeals that will involve research of member benefits, eligibility, provider contracts, billing and coding, Utilization Management and state Medicaid policies.
Qualifications/Skills Needed:
1-2 years of Appeals and Grievance
1 yr. medical claims processing experience (Must be with a healthcare plan, not on behalf of provider or provider’s office)
Medicaid insurance customer service or claims processing
Medicaid/Medicare Insurance Customer Service with managed care plans or directly with CMS
Billing and Coding-Medical Insurance
Knowledge of Member/Provider Appeals and Grievances, processes, resolutions, compliance TAT
Self-resolved troubleshooting ability for various IT issues
Knowledge of QNXT
Knowledge of PEGA
Knowledge of SharePoint
Sense of urgency with production and responsiveness to email and MS Teams
Ability to create and fax written communication in a professional manner including spelling and grammar.
Salary and Other Compensation:
The hourly rate for this position is between $17.00 – 18.00 per hour, depending on experience and other qualifications of the successful candidate.
This position is also eligible for Cognizant’s discretionary annual incentive program, based on performance and subject to the terms of Cognizant’s applicable plans.
Benefits: Cognizant offers the following benefits for this position, subject to applicable eligibility requirements: • Medical/Dental/Vision/Life Insurance • Paid holidays plus Paid Time Off • 401(k) plan and contributions • Long-term/Short-term Disability • Paid Parental Leave • Employee Stock Purchase Plan
Disclaimer: The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.
The Cognizant community:
We are a high caliber team who appreciate and support one another. Our people uphold an energetic, collaborative and inclusive workplace where everyone can thrive.
- Cognizant is a global community with more than 300,000 associates around the world.
- We don’t just dream of a better way – we make it happen.
- We take care of our people, clients, company, communities and climate by doing what’s right.
- We foster an innovative environment where you can build the career path that’s right for you.
About us:
Cognizant is one of the world's leading professional services companies, transforming clients' business, operating, and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build, and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant (a member of the NASDAQ-100 and one of Forbes World’s Best Employers 2024) is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com
Cognizant is an equal opportunity employer. Your application and candidacy will not be considered based on race, color, sex, religion, creed, sexual orientation, gender identity, national origin, disability, genetic information, pregnancy, veteran status or any other characteristic protected by federal, state or local laws.
Disclaimer:
Compensation information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.
Applicants may be required to attend interviews in person or by video conference. In addition, candidates may be required to present their current state or government issued ID during each interview.
