SCA Appeals Representative I- PS38517
Vacancy expired!
Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At National Government Services
(NGS), an independent subsidiary of Anthem,
Inc. and one of the largest Medicare contractors in the country, it’s a
powerful combination. It’s the
foundation upon which we’re creating greater access to care for our members,
greater value for our customers and greater health for our communities. Join us
and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that
means more to you and those we serve. The SCA Appeals Representative I position
in the NGS Appeals Department that reviews, analyzes and processes non-complex
pre service and post service grievances and appeals requests from customer
types (i.e. member, provider, regulatory and third party) and multiple products
(Part B) related to clinical and non-clinical services, quality of service, and
quality of care issues to include executive and regulatory grievances. Primary duties
may include, but are not limited to:
Reviews, analyzes and processes non-complex
grievances and appeals in accordance with external accreditation and regulatory
requirements, internal policies and claims events requiring adaptation of
written response in clear, understandable language.
Utilizes guidelines and review tools to conduct
extensive research and analyze the grievance and appeal issue(s) and pertinent
claims and medical records to either approve or summarize and route to nursing
and/or medical staff for review.
The grievance and appeal work is subject to
applicable accreditation and regulatory standards and requirements.
As such, the analyst will strictly follow
department guidelines and tools to conduct their reviews. Analyzes and renders
determinations on assigned non-complex grievance and appeal issues and
completion of the respective written communication documents to convey the
determination.
Responsibilities exclude conducting any
utilization or medical management review activities which will require the
interpretation of clinical information.
The analyst may serve as a liaison between grievances
& appeals and /or medical management, legal, and/or service operations and
other internal departments.
Qualifications Training hours: 2 month training class Monday through Friday
7:30am- 4:00pm hours may varyAttendance during training is considered mandatory with time
off highly discouraged Work hours: Monday through Friday starting between 6:00am –
10:00am working an 8 hour shiftHourly rates are non-negotiable:Broward
County, FL15.02Bryan
County, OK14.30Cincinnati,
OH14.49Cooke
County, TX13.56Denison,
TX14.47Harrisburg,
PA15.01Hingham,
MA16.46Indianapolis,
IN14.45Kanawha
County, WV13.32Lamar
County, TX13.80Louisville,
KY13.92Manchester,
NH15.63Mason
County, OH13.97Milwaukee,
WI15.40Philadelphia,
PA14.68Pinal
County, AZ13.78Richmond,
VA13.85South
Portland, ME15.26Syracuse,
NY13.87Requires a High school diploma or
GED; up to 2 years’ experience working in grievances and appeals, claims, or
customer service, familiarity with medical coding and medical terminology,
demonstrated business writing proficiency, understanding of provider networks,
the medical management process, claims process, all of the company's internal
business processes, and internal local technology; or any combination of
education and/or experience which would provide an equivalent background.Preferred skills
Review medical records experience
Strong written communications- must be able to compose
professional correspondence
Billing/claims experience
Must be computer savvy- able to navigate between screens
Must be able to read SOP’s to understand the
process/procedures and be comfortable to make the appropriate decision to complete
the appeal
Anthem, Inc. is ranked as one of
America’s Most Admired Companies among health insurers by Fortune magazine and
is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more
about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.REQNUMBER: PS38517
Vacancy expired!