Healthfirst logo
Healthfirst

We provide no-and low-cost health insurance in NYC, Long Island, Orange, Rockland, Sullivan, and Westchester counties.

Appeals Specialist

GeneralGeneralFull TimeRemoteMid LevelTeam 1,001-5,000Since 1993H1B SponsorCompany SiteLinkedIn

Location

New York

Posted

2 days ago

Salary

$58.9K - $80.1K / year

Seniority

Mid Level

High School2 yrs expEnglish

Job Description

Appeals Specialist

Healthfirst

• Responsible for case development and resolution of non-clinical cases • Research issues • Reference and understand HF’s internal health plans’ policies and procedures to frame decisions • Interpret regulations • Resolve cases and make critical decisions • Edit and finalize resolution letters • Manage all duties within regulatory timeframes • Communicate effectively to hand-off or pick-up work from colleagues • Work within a framework that measures productivity and quality • Prepare and submit well documented appeals in accordance with payer guidelines • Identify patterns or trends in denials and provide feedback for leadership.

Job Requirements

  • HS Diploma or GED from an accredited institution
  • Minimum of two (2) years of work experience in Managed Care Health Insurance Plan
  • Experience with appeals for Medicare, Medicaid, Dual enrollment and commercial Plans end to end
  • Claims processing experience with coding criteria is preferred
  • Demonstrated critical thinking and decision-making competencies
  • Demonstrated ability to be detail oriented, work under pressure, manage tight timeframes

Benefits

  • medical, dental and vision coverage
  • incentive and recognition programs
  • life insurance
  • 401k contributions

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