Appeals Hearing Specialist Position Available In Palm Beach, Florida

Job Description:

The RCO Appeals Hearing Specialist is responsible for investigating, coordinating and managing legal insurance cases and represents Intermountain Health in OIG hearings and 1st level grievances with insurance companies and CMS. This position communicates regularly with various levels of internal and external personnel and works closely with Intermountain Health legal team, Physician Advisors, and Appeals RN consultants in their various capacities. Fully remote position! Essential Functions Serves as the Intermountain Appeals liaison to Legal, Appeals RN Consultants, Physician Advisors, Payor Contracting and various internal and external departments within Intermountain Healthcare. Understands ERISA, self-funded and federal and state laws around health insurance claims. Develops and maintains collaborative relations with Intermountain legal, physicians and RN Consultants to coordinate and conduct grievance hearings. 1) Provides detailed review summary to assist attorneys/physician advisors 2) Participates through representation in formal grievance hearings, medical review boards and courts of law 3) Educates third party payers, ALJ’s and appeal boards during hearing processes related to patient’s clinical condition or care rendered. Assists the legal department and outside legal counsel in preparation for disputes being reviewed through mediation, small claims court and other civil actions including arbitration that are not being resolved through the formal appeal process. Stays current with emerging hearing procedures for all encompassed commercial, federal and state funded insurances/programs. Acts with minimal supervision while making many complex decisions daily within the scope of the position. Keeps staff educated on all current trends in the appeals arena. Educates employees on current trends in the appeals area by researching procedures and processes for appealing all levels offered by each insurance company and all applications of state and federal laws as they pertain. Serves as a subject matter expert, resource and mentor to others within the RCO, clinical departments, Appeal RN’s, legal, IPAS and Payor Contracting on the art of appealing. Skills Critical thinking Healthcare law Communication Organizational skills Computer Literacy Medical terminology

Problem Solving Health Insurance Collaboration Detail-oriented Physical Requirements:

Qualifications Required Demonstrated experience working as a legal assistant, hearing officer, paralegal or in a compliance support role. Demonstrates strong ability to connect/collaborate with internal and external customers to provide training and education. Demonstrated knowledge of Revenue Cycle and health insurance industry. Demonstrates excellent written communication skills. Demonstrates in-depth knowledge of state and federal laws governing health insurance contracts and the appeal process. Demonstrated proficiency in computer skills including Microsoft Office, internet and email required. Preferred Bachelor’s degree in legal related field from an accredited institution. Education will be verified. Paralegal certificate. Experience with Epic . Physical Requirements Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs. Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately. Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc. May have the same physical requirements as those of clinical or patient care jobs, when the leader takes clinical shifts.

For roles requiring driving:

Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location:

Lake Park Building Work City:

West Valley City Work State:

Utah Scheduled Weekly Hours:

40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $29.66 – $46.72 We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package here. Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. At Intermountain Health, we use the artificial intelligence (“AI”) platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process. All positions subject to close without notice. Intermountain Health is a Utah-based, not-for-profit system of 33 hospitals (includes “virtual” hospital), a Medical Group with more than 3,800 physicians and advanced practice clinicians at about 385 clinics, a health plans division called Select Health, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery. Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment. To find out more about us, head to our career site here. Sign up for job alerts! Click ‘sign in’ at the top right corner, create a candidate account, and when we have opportunities that meet your interests, you will receive an email with the job details. Intermountain Health strives to make the application process accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact 1-800-843-7820 or email recruitment@imail.org. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. Introduce yourself to our Talent Acquisition team and we will get in touch if there is a role that seems like a good match. Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more. The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor. All positions subject to close without notice. Thanks for your interest in continuing your career with our team!