Appeals Representative II

Appeals Representative

The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, and industry standards, along with CMS and state guidelines. This role ensures that all appeals are set up accurately and in a timely manner, supporting the appeal process efficiently.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Receiving and analyzing appeal documentation to determine appropriate actions
• Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents
• Ensure compliance with HIPAA, CMS guidelines, and client instructions and policy standards
• Utilize applicable tools and resources to complete setup
• Additional duties as assigned

KNOWLEDGE & SKILLS:

• Knowledge of Medicare, Medicaid, and commercial insurance guidelines
• Strong attention to detail, time management, and organizational skills
• Excellent written and verbal communication skills
• Knowledge of medical terminology and CPT/ICD codes
• Proficiency with Microsoft applications

EDUCATION & EXPERIENCE:

• High school diploma or equivalent
• 1+ years of experience in healthcare, insurance, claim processing, or customer service
• 1+ years working with customers in a fast-paced, deadline-oriented environment
• 1+ years of experience as an Appeals Representative
• Strong technical skills with the ability to work across multiple software systems and work remotely with self-management skills

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: $20.08 - $30.06 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

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, 401 K, ROTH 401 K, and paid time off.

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