Appeals Representative II

Appeals Representative II

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 role.

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: $18.80 - $30.34 per hour

About CERiS:

CERiS, a division of CorVel Corporation, a certified Great Place to Work Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.