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SKYGEN logo
SKYGEN

SKYGEN is the trusted partner for specialty benefits payers and government agencies responsible for the delivery and administration of dental and vision benefits. Through cutting-edge technology and service solutions, SKYGEN empowers clients to become the most efficient, effective healthcare organizations in the country.

Appeals & Complaints Specialist I

Billing SpecialistBilling SpecialistFull TimeRemoteMid LevelTeam 501-1,000

Location

Worldwide

Posted

23 days ago

Salary

$18 - $26 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Appeals & Complaints Specialist I

SKYGEN

Role Description This position is eligible for fully permanent remote work, allowing you to work from anywhere. - Schedule: Monday to Friday, with typical day shift hours from 8:00 AM to 5:00 PM CST. - Possible Weekend or Extended Hours: There may be occasional weekend or extended hours to meet contract deadlines or urgent requirements. - Holiday Coverage: Some flexibility will be needed for holiday coverage depending on business needs. What will YOU be doing for us? - Review, analyze, and process complaints and appeals regarding dental and vision services. - Communicate with both internal and external entities to resolve complex payment disputes, quality of care issues, and requests for appeal regarding the denial of healthcare and/or dental services. What will YOU be working on every day? - Analyze, triage, investigate, research, and process standard and escalated appeals, complaints or state complaints from members, providers, health plans, and state agencies. - Communicate effectively with internal staff, members, and providers in the investigation and resolution of various appeals, complaints, and grievances. - Accurate data entry and documentation of all appeal, complaint, and grievance activity for reporting and trending analysis. - Accurately create formal correspondence to confirm receipt and provide resolution for member and provider complaints and appeal requests. - Analyze and process all inbound mail scans and enterprise follow-up communication to the Appeals department. - Maintain strict compliance by utilizing Open Inventory Report, DASH, and regulatory standards for appeal and grievance turnaround times and documentation requirements. - Immediately notify a member of department leadership or quality auditor of potential compliance risk. - Participate in client audits and SKYGEN reaccreditation audits and interviews. - Utilize all job aids, work instructions, and step actions available to maintain current knowledge and understanding of existing processes based on delegated responsibilities. - Participate in job aid creation or updates in collaboration with ACG III and IV. - Utilize assigned team-specific chats while communicating effectively and in a professional manner as it relates to work assignments. Qualifications - Required Level of Education, Licenses, and/or Certificates: High school diploma or equivalent required. - Required Level of Experience: - 1 plus years of job-related experience (such as billing, problem solving, researching, etc.). - 1 plus years of job-related experience interacting with customers and clients. - Required Knowledge, Skills, and Abilities: - Knowledge of general computer software; to include competencies in Outlook, Excel, and MS Word. - Ability to work overtime as needed. - Ability to communicate effectively and engage in a remote environment. - Ability to work through challenging issues with others in a professional manner. - Accurate inventory management including data entry, time management, and typing skills. - Strong verbal and written communication skills. - Ability to draft letters with strong attention to accuracy and grammar. Requirements - Preferred Level of Experience: - Previous experience processing appeals or complaints in a healthcare setting. - 2 years of prior job-related experience (Dental Assistant, Dental Office Manager, Dental front office, or health/dental insurance, including managed care operations, accounts receivable, and/or billing). - Preferred Knowledge, Skills, and Abilities: - Ability to resolve complex problems. - Ability to work autonomously. - Experience working in a dental environment. - Ability to successfully have crucial conversations to resolve assigned appeals or complaints. Benefits - Compensation Range: $17.55/hr – $26.34/hr - Compensation Midpoint: $21.94/hr

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UN Women logo

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