Appeals Specialist

🔥 21 hours ago

🗽 New York – Remote

🗽 New York – Remote

💵 $58.9k - $80.1k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Healthfirst

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1993

⚕️ Healthcare Insurance

💸 Finance

Healthcare Insurance • Finance • Medicare

Healthfirst is a health insurance provider dedicated to helping New Yorkers access affordable health coverage for individuals and families. With over 30 years of experience, Healthfirst offers a range of plans including Medicaid managed care, Medicare Advantage, long-term care, and essential health plans. The company focuses on providing quality healthcare options, comprehensive benefits, and support to ensure members can maintain their health and well-being.

📋 Description

• 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.

🎯 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