Temp - Administrative - Appeals Specialist; Flint MI

Position: Temp - Administrative - Appeals Specialist (Days) Flint MI
Responsible for assisting with coordination of all appeal/grievance activity for the Plan. Responsible for ensuring departmental compliance with applicable regulations and tracking appeal and grievance activity, complying with state and regulatory standards. Assists in preparing and researching case files as necessary. Responsible for research and resolution of member and provider claims issues. Responsible for assisting with member and provider education opportunities regarding complaints/grievances/appeals.

Identifies process improvement opportunities and develops plans to address opportunities.
Requirement description :

• This is a 52% markup need. Contractors need to make a facility mandated   per hour
• High school diploma or equivalent (GED) - Required
• One year experience in healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology - Required
• Attention to detail, excellent grammar skills, the ability to multitask and work independently once trained - Required
• Associate degree in business, health care or related field - Preferred
• Two (2) years' experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. administration, medical delivery, regulatory compliance, claims processing, membership/eligibility) - Preferred
• Two (2) years healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology - Preferred

Profile Requirements:

• Work history only
• Please do not include any drivers license or personal documents

ADDITIONAL LICENSE REQUIREMENTS :
Weekend Requirements :
None
On Call Requirements :
None