Temporary Appeals Specialist

Review and complete redeterminations, effectuation of claims. This position is responsible for responding to written redetermination requests and inquiries from physicians, suppliers, beneficiaries, providers, attorneys, other contractors, and CMS. The incumbent is responsible for researching the case, composing written replies, processing claims and/or adjustments, responding to and initiating complex written correspondence, explaining Medicare appeal policies and procedures, as well as specific claim decisions through written and oral communications. The incumbent will accomplish this by using telephone communication, adjustment, coding and pricing skills and responding in a professional manner while meeting CMS standards (accuracy, readability, timeliness, tone and clarity).
High School Diploma, Computer/communication skills, analytical, claims processing and CPT coding preferred, claims adjustments, teamwork. Appeals experience, Multi Carrier System (MCS) experience, claims adjustment experience, suspense experience.

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