[Remote-Position] Medicare Claims Appeals Specialist
Your next career move could be with workwarp as a Medicare Claims Appeals Specialistpart-time/flexible Hours! Embrace a modern work style with this fully Remote opportunity. This position requires a strong and diverse skillset in relevant areas to drive success. We are prepared to offer a competitive salary to attract a top-tier candidate for this role. ร ร Job Title: Part-Time Medicare Claims Appeals Specialist
Organization: Managed Care Organization...
Location: Remote, PST Time Zone Candidates Only
Pay: $22/hr.
Schedule
รย Part-time, 20-32 hours per week
รย Flexible hours, including AM or PM shifts (e.g., 4-10 pm, 6-10 pm)
รย Optional weekend hours available
รย Schedule will be reviewed with the hiring manager during the interview
Job Description
The Medicare Claims Appeals Specialist will be responsible for reviewing and processing provider appeals for Medicare cases, primarily focused on California operations. This role requires a deep understanding of Medicare claims processes, provider contracts, Division of Financial Responsibility (DOFR), explanations of benefits, and claims edits. Knowledge of CMS provider appeals regulations, including Independent Review Entity (IRE) processes and strict adherence to timelines, is essential.
Key Responsibilities
รย Manage the comprehensive research and resolution of Medicare provider appeals, disputes, and grievances in compliance with CMS regulations and internal timelines.
รย Research claims, appeals, and grievances using support systems to determine appropriate outcomes.
รย Request and review medical records, notes, or detailed billing when necessary, formulating conclusions as per protocols.
รย Maintain a production standard and ensure that responses meet state, federal, and organizational guidelines.
รย Accurately apply contract language and benefits coverage for provider and member cases.
รย Prepare concise, compliant written correspondence and documentation on appeals, grievances, or disputes, ensuring clarity and accuracy.
รย Conduct root cause analysis for payment errors related to provider contracts, fee schedules, and system configurations.
รย Provide clear, professional written and verbal communication to members, providers, or authorized representatives regarding resolution outcomes.
Must-Have Skills
รย Exceptional communication skills (both verbal and written)
รย Highly organized with a strong ability to prioritize tasks and meet deadlines
รย Strong strategic skills, including initiative, problem-solving, critical thinking, judgment, and innovation
Knowledge/Skills/Abilities
รย Thorough understanding of Medicare claims processing, provider contracts, DOFR, and claims edits
รย Familiarity with Medicaid and Medicare claims denials and appeals processing, including knowledge of CMS appeals timelines and regulatory guidelines
รย Experience with claims processing functions, including coordination of benefits, subrogation, and eligibility criteria
Qualifications
รย Education: High School Diploma or equivalent
รย Experience: Minimum 2 years of experience in a managed care operational role, preferably in a call center, appeals, or claims environment, with a health claims processing background Apply Job!ร Ready to Apply?If you are a motivated individual ready to contribute to a thriving team, we encourage you to apply now! We are excited to review your application.
Apply Now
Organization: Managed Care Organization...
Location: Remote, PST Time Zone Candidates Only
Pay: $22/hr.
Schedule
รย Part-time, 20-32 hours per week
รย Flexible hours, including AM or PM shifts (e.g., 4-10 pm, 6-10 pm)
รย Optional weekend hours available
รย Schedule will be reviewed with the hiring manager during the interview
Job Description
The Medicare Claims Appeals Specialist will be responsible for reviewing and processing provider appeals for Medicare cases, primarily focused on California operations. This role requires a deep understanding of Medicare claims processes, provider contracts, Division of Financial Responsibility (DOFR), explanations of benefits, and claims edits. Knowledge of CMS provider appeals regulations, including Independent Review Entity (IRE) processes and strict adherence to timelines, is essential.
Key Responsibilities
รย Manage the comprehensive research and resolution of Medicare provider appeals, disputes, and grievances in compliance with CMS regulations and internal timelines.
รย Research claims, appeals, and grievances using support systems to determine appropriate outcomes.
รย Request and review medical records, notes, or detailed billing when necessary, formulating conclusions as per protocols.
รย Maintain a production standard and ensure that responses meet state, federal, and organizational guidelines.
รย Accurately apply contract language and benefits coverage for provider and member cases.
รย Prepare concise, compliant written correspondence and documentation on appeals, grievances, or disputes, ensuring clarity and accuracy.
รย Conduct root cause analysis for payment errors related to provider contracts, fee schedules, and system configurations.
รย Provide clear, professional written and verbal communication to members, providers, or authorized representatives regarding resolution outcomes.
Must-Have Skills
รย Exceptional communication skills (both verbal and written)
รย Highly organized with a strong ability to prioritize tasks and meet deadlines
รย Strong strategic skills, including initiative, problem-solving, critical thinking, judgment, and innovation
Knowledge/Skills/Abilities
รย Thorough understanding of Medicare claims processing, provider contracts, DOFR, and claims edits
รย Familiarity with Medicaid and Medicare claims denials and appeals processing, including knowledge of CMS appeals timelines and regulatory guidelines
รย Experience with claims processing functions, including coordination of benefits, subrogation, and eligibility criteria
Qualifications
รย Education: High School Diploma or equivalent
รย Experience: Minimum 2 years of experience in a managed care operational role, preferably in a call center, appeals, or claims environment, with a health claims processing background Apply Job!ร Ready to Apply?If you are a motivated individual ready to contribute to a thriving team, we encourage you to apply now! We are excited to review your application.
Apply Now