A&G Dismissal Specialist Position Available In [Unknown county], Florida
Tallo's Job Summary: A&G Dismissal Specialist position entails resolving non-clinical cases, such as claim denials and provider appeals. Responsibilities include researching issues, interpreting regulations, and communicating effectively. Minimum qualifications include work experience in appeals or healthcare, customer service skills, and proficiency in Microsoft Office Suite. The employer is an equal opportunity employer.
Job Description
- Duties and Responsibilities
- + Responsible for case development and resolution of non-clinical cases, such as: certain types of claim denials, member complaints, and non-par provider appeals.
The end to end process requires the Specialist to independently: + Research issues + Understand claim denials + Communicate with other departments to confirm submitter information + Reference and understand HFs internal health plans policies and procedures to frame decisions + Interpret regulations + Resolve cases and make critical decisions + Edit and finalize resolution letters + Manage all duties within regulatory timeframes + Communicate effectively to hand-off or pick-up work from colleagues + Work within a framework that measures productivity and quality for each Specialist against expectations + Additional duties as assigned
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Minimum Qualifications:
- + Proven work experience with appeals and grievances or healthcare environment.
+ Work experience demonstrating verbal and written communication skills. + Customer service experience including resolving escalated customer complaints or concerns. + Experience handling complex situations and/or projects. + Proficient in Microsoft Office Suite applications including Excel, Word, Power Point, and Outlook. + Working experience using MS Excel to sort, filter, and track trends with claims errors to provide resolution. + Ability to work flexible hours, weekends, and evenings due to business needs. + High School Diploma or GED from an accredited institution.
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Preferred Qualifications:
- + Experience with OnBase + Bachelors Degree from an accredited institution + Working experience using MS Excel to sort, copy and paste, as well as experience creating and using pivot tables. + Frequently communicates complex information and interacts with management. Can present, resolve conflicts, and address delicate situations.
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Compliance & Regulatory Responsibilities:
See Above
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License/Certification:
N/A
- WE
ARE AN EQUAL OPPORTUNITY EMPLOYER.
Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
