Health Admin Services Associate - INC

Overview

Health Admin Services Associate in the Healthcare Claims team, handling administration of health claims including Medicare Part C and Part D appeals and grievances.

What you'll do

• Handle end-to-end appeal processing.
• Perform AOR validation and provider outreach.
• Review denial rationale and supporting clinical documentation.
• Prepare cases for Medical Director review.
• Process determinations and effectuation activities.
• Solve routine problems largely through precedent and referral to general guidelines.
• Carry out core claim processing such as registering claims, editing and verification, claims evaluation, and examination and litigation.

What you'll need

• Any graduation.
• Graduate degree.
• 2 to 4 years healthcare operations experience.
• Experience in Medicare Appeals and Grievances processing.
• Experience with Medicare Part C and Part D appeals.
• Knowledge of CMS regulations and turnaround requirements.

Details

• Rotational shifts may be required.
• Detailed to moderate level of instruction on daily tasks; detailed instruction on new assignments.
• Individual contributor within a team, with a predetermined, focused scope of work.