SCA Appeals Representative I
Description SHIFT:
Day Job SCHEDULE:
Full-time Your Talent.
Our Vision.
At National Government Services(NGS), an independent subsidiary of Anthem,Inc.
and one of the largest Medicare contractors in the country, its apowerful combination.
Its thefoundation upon which were creating greater access to care for our members,greater value for our customers and greater health for our communities.
Join usand together we will drive the future of health care.
This is an exceptional opportunity to do innovative work thatmeans more to you and those we serve.
The SCA Appeals Representative I positionin the NGS Appeals Department that reviews, analyzes and processes non-complexpre service and post service grievances and appeals requests from customertypes (ie member, provider, regulatory and third party) and multiple products(Part B) related to clinical and non-clinical services, quality of service, andquality of care issues to include executive and regulatory grievances.
Primary dutiesmay include, but are not limited to:
Reviews, analyzes and processes non-complexgrievances and appeals in accordance with external accreditation and regulatoryrequirements, internal policies and claims events requiring adaptation ofwritten response in clear, understandable language.
Utilizes guidelines and review tools to conductextensive research and analyze the grievance and appeal issue(s) and pertinentclaims and medical records to either approve or summarize and route to nursingand/or medical staff for review.
The grievance and appeal work is subject toapplicable accreditation and regulatory standards and requirements.
As such, the analyst will strictly followdepartment guidelines and tools to conduct their reviews.
Analyzes and rendersdeterminations on assigned non-complex grievance and appeal issues andcompletion of the respective written communication documents to convey thedetermination.
Responsibilities exclude conducting anyutilization or medical management review activities which will require theinterpretation of clinical information.
The analyst may serve as a liaison between grievances& appeals and /or medical management, legal, and/or service operations andother internal departments.
Qualifications Training hours:
2 month training class Monday through Friday7:
30am- 4:
00pm hours may vary Attendance during training is considered mandatory with timeoff highly discouraged Work hours:
Monday through Friday starting between 6:
00am 10:
00am working an 8 hour shift Hourly rates are non-negotiable:
BrowardCounty, FL 15.
02 BryanCounty, OK 14.
30 Cincinnati,OH 14.
49 CookeCounty, TX 13.
56 Denison,TX 14.
47 Harrisburg,PA 15.
01 Hingham,MA 16.
46 Indianapolis,IN 14.
45 KanawhaCounty, WV 13.
32 LamarCounty, TX 13.
80 Louisville,KY 13.
92 Manchester,NH 15.
63 MasonCounty, OH 13.
97 Milwaukee,WI 15.
40 Philadelphia,PA 14.
68 PinalCounty, AZ 13.
78 Richmond,VA 13.
85 SouthPortland, ME 15.
26 Syracuse,NY 13.
87 Requires a High school diploma orGED; up to 2 years experience working in grievances and appeals, claims, orcustomer 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 internalbusiness processes, and internal local technology; or any combination ofeducation and/or experience which would provide an equivalent background.
Preferred skills Review medical records experience Strong written communications- must be able to composeprofessional correspondence Billing/claims experience Must be computer savvy- able to navigate between screens Must be able to read SOPs to understand theprocess/procedures and be comfortable to make the appropriate decision to completethe appeal Anthem, Inc.
is ranked as one ofAmericas Most Admired Companies among health insurers by Fortune magazine andis a 2018 DiversityInc magazine Top 50 Company for Diversity.
To learn moreabout our company and apply, please visit us at careers.
antheminc.
com.
An Equal Opportunity Employer/Disability/Veteran.
REQNUMBER:
PS38517.
Estimated Salary: $20 to $28 per hour based on qualifications.
Day Job SCHEDULE:
Full-time Your Talent.
Our Vision.
At National Government Services(NGS), an independent subsidiary of Anthem,Inc.
and one of the largest Medicare contractors in the country, its apowerful combination.
Its thefoundation upon which were creating greater access to care for our members,greater value for our customers and greater health for our communities.
Join usand together we will drive the future of health care.
This is an exceptional opportunity to do innovative work thatmeans more to you and those we serve.
The SCA Appeals Representative I positionin the NGS Appeals Department that reviews, analyzes and processes non-complexpre service and post service grievances and appeals requests from customertypes (ie member, provider, regulatory and third party) and multiple products(Part B) related to clinical and non-clinical services, quality of service, andquality of care issues to include executive and regulatory grievances.
Primary dutiesmay include, but are not limited to:
Reviews, analyzes and processes non-complexgrievances and appeals in accordance with external accreditation and regulatoryrequirements, internal policies and claims events requiring adaptation ofwritten response in clear, understandable language.
Utilizes guidelines and review tools to conductextensive research and analyze the grievance and appeal issue(s) and pertinentclaims and medical records to either approve or summarize and route to nursingand/or medical staff for review.
The grievance and appeal work is subject toapplicable accreditation and regulatory standards and requirements.
As such, the analyst will strictly followdepartment guidelines and tools to conduct their reviews.
Analyzes and rendersdeterminations on assigned non-complex grievance and appeal issues andcompletion of the respective written communication documents to convey thedetermination.
Responsibilities exclude conducting anyutilization or medical management review activities which will require theinterpretation of clinical information.
The analyst may serve as a liaison between grievances& appeals and /or medical management, legal, and/or service operations andother internal departments.
Qualifications Training hours:
2 month training class Monday through Friday7:
30am- 4:
00pm hours may vary Attendance during training is considered mandatory with timeoff highly discouraged Work hours:
Monday through Friday starting between 6:
00am 10:
00am working an 8 hour shift Hourly rates are non-negotiable:
BrowardCounty, FL 15.
02 BryanCounty, OK 14.
30 Cincinnati,OH 14.
49 CookeCounty, TX 13.
56 Denison,TX 14.
47 Harrisburg,PA 15.
01 Hingham,MA 16.
46 Indianapolis,IN 14.
45 KanawhaCounty, WV 13.
32 LamarCounty, TX 13.
80 Louisville,KY 13.
92 Manchester,NH 15.
63 MasonCounty, OH 13.
97 Milwaukee,WI 15.
40 Philadelphia,PA 14.
68 PinalCounty, AZ 13.
78 Richmond,VA 13.
85 SouthPortland, ME 15.
26 Syracuse,NY 13.
87 Requires a High school diploma orGED; up to 2 years experience working in grievances and appeals, claims, orcustomer 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 internalbusiness processes, and internal local technology; or any combination ofeducation and/or experience which would provide an equivalent background.
Preferred skills Review medical records experience Strong written communications- must be able to composeprofessional correspondence Billing/claims experience Must be computer savvy- able to navigate between screens Must be able to read SOPs to understand theprocess/procedures and be comfortable to make the appropriate decision to completethe appeal Anthem, Inc.
is ranked as one ofAmericas Most Admired Companies among health insurers by Fortune magazine andis a 2018 DiversityInc magazine Top 50 Company for Diversity.
To learn moreabout our company and apply, please visit us at careers.
antheminc.
com.
An Equal Opportunity Employer/Disability/Veteran.
REQNUMBER:
PS38517.
Estimated Salary: $20 to $28 per hour based on qualifications.
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