申诉代表 II
Appeals Representative II
负责通过电子邮件、传真、电话或书面通讯处理提供者的查询和申诉，确保遵守客户政策、行业标准以及CMS和州指南以及客户指示。
这是一个远程职位。
核心职责与工作内容：
- 按照客户政策、CMS指南和行业标准，以清晰专业的书面沟通方式审查、分析并完成申诉
- 能够正确解读提供者的申诉并运用分析思维技能
- 能够理解客户政策和CMS指南，特别是CERiS所做的审查，如明细账单等
- 使用适用的工具和资源完成申诉
- 及时完成申诉
- 其他指派的任务
知识与技能：
- 需具备住院和门诊医院收入周期的相关知识
- 优秀的书面和口头沟通能力
- 合同解读、医学术语和编码知识
- 熟练使用微软办公软件
教育与经验：
- 高中毕业或同等学历
- 3年以上医疗收入周期经验（包括催收、申诉、拒付管理等）
- 2年以上在快节奏、以截止日期为导向的环境中与客户工作的经验
- 2年以上作为申诉代表的经验
- 具备良好的细节关注、组织和时间管理能力，能够解读、研究并识别核心问题
- 强烈的客户服务意识、分析和决策能力
- 强大的技术能力，能够在多个软件系统间工作，并适应在家远程办公
薪资范围：
CorVel采用基于市场的薪酬方式，我们的薪资范围可能因您所在的位置而有所不同。薪资水平的确定会考虑以下因素：联邦、州和地方最低工资要求、地理差异、与工作相关的技能、经验、资格、内部员工公平性以及市场状况。我们的薪资范围可能会随时调整。
对于分级职位（I、II、III、高级、主管等），新员工可能根据面试期间的评估结果被分配到不同的级别，无论是上调还是下调，这将综合考虑经验、资格和岗位整体匹配度。职级可能会影响薪资范围，这些调整将在录用过程中明确说明。
薪资范围：$
查看英文原文
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.
Originally posted on Himalayas