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The Appeals Representative is responsible for addressing provider inquiries and appeals via email, fax, telephone, or written correspondence ensuring adherence to client policy, industry standards along with CMS and state guidelines as well as client instructions.
This is a remote role.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
Reviews, analyzes, and completes appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication
Ability to appropriately interpret provider appeals and apply analytical thinking skills
Ability to interpret client policy and CMS guidelines as it relates to reviews done by CERiS such as itemized bill
Utilize applicable tools and resources to complete appeals
Timely completion of appeals
Additional duties as assigned
KNOWLEDGE & SKILLS:
Prior knowledge of inpatient and outpatient hospital revenue cycle required
Excellent written and verbal communication skills
Contract interpretation, medical terminology and coding knowledge
Proficiency with Microsoft applications
EDUCATION & EXPERIENCE:
High school diploma or equivalent
3+ years of healthcare revenue cycle experience (collections, appeals, denials management, etc)
2+ years working with customers in a fast‐paced, deadline‐oriented environment
2+ years experience as an Appeals Representative
Strong attention to detail, organizational and time management skills with the ability to interpret, research and identify core issues
Strong customer focus, analytical and decision making skills
Strong technical skills with the ability to work across multiple software systems and comfortable work remote out of your home
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: $18.80 - $30.34 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, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.