Appeals Specialist

Job Description

REQUIREMENTS

• High School Diploma or equivalent required.
• Associate’s or Bachelor’s degree preferred.
• Minimum of 2 years of relevant experience in healthcare, insurance, or Medicare/Medicaid services.
• Customer service experience preferred.
• Medicare-specific experience preferred but not required; comprehensive training provided.
• Proficiency with Microsoft Office (Word, Excel, Outlook).
• Strong organizational skills with excellent attention to detail.
• Effective written and verbal communication skills.
• Demonstrated ability to exercise sound judgment and handle confidential information.
• Strong spelling, grammar, and punctuation skills.

RESPONSIBILITIES

• 50% – Perform non-medical reviews and process redetermination letters, ensuring accuracy and compliance with established timelines.
• 30% – Prepare unit reports, analyze and interpret workload data, and address processing issues using various software tools.
• 10% – Update letters, templates, and departmental documents as needed.
• 10% – Gather and prepare documentation for legal inquiries and administrative requests.

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