Appeals Team Lead

About This Role

Lead an appeals team, providing expertise in reviewing, researching, investigating, and resolving various appeals and grievances within a healthcare setting. This role involves coordinating with internal departments and ensuring compliance with regulatory guidelines.

Responsibilities

• Answer team questions as needed
• Monitor and work QC queue
• Distribute appeals to the team
• Review appeal submission documentation for relevant information and take action
• Review original findings for issues and/or errors
• Consult with internal parties and seek clarification when necessary
• Create appeal responses that appropriately address issues raised
• Follow department processes and protocols for the appeal process
• Coordinate special instructions/requests with other internal departments
• Maintain working knowledge of Worker’s Compensation, Medicare, and Medicaid rules and CERIS policies

Requirements

• 3+ years in healthcare customer service or insurance collections field
• Experience working with customer support/client issue resolution management
• Proven strong leadership skills
• Knowledge of Medicare (CMS) and Medicaid regulations, regulatory compliance, Managed Care, and medical claims processing guidelines
• MS Word, Excel and Outlook experience beyond basic functionality (pivot tables, conditional formatting, advanced formulas)
• Familiarity with medical terminology, medical coding, and medical billing regulations

Qualifications

• 3+ years in healthcare customer service or insurance collections field, with experience in customer support/client issue resolution management

Skills

* Required skills

Benefits