appeals specialist ii.detroit, michigan (remote)posted 6 days ago job detailssummary$22.99 - $23 per hourtemporaryhigh schoolcategoryoffice and administrative support occupations reference AB_5064871 job details Support the team to ensure appeals, disputes and reconsiderations are reviewed and processed timely.

Education/Experience:

Requires a High School diploma or GED. Requires 1 - 2 years of related experience Knowledge of appeals, disputes and reconsiderations process preferred. Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up Conducts research needed to evaluate, process, and respond to appeals, disputes and reconsiderations to ensure a timely decision Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes and reconsiderations Gathers appeals, disputes and reconsiderations data to track and report on trends and final outcomes to team including conducting outreach for an update on statuses, determinations, and explanations Performs other duties as assigned Complies with all policies and standards Top 3 must-have hard skills stack-ranked by importance 1 Authorization Building 2 Utilization Management 3

Critical Thinkingsalary:

$22.99 - $23 per hourshift: Firstwork hours: 8 AM - 5

PMeducation:

High SchoolResponsibilitiesPerforms data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up Conducts research needed to evaluate, process, and respond to appeals, disputes and reconsiderations to ensure a timely decision Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes and reconsiderations Gathers appeals, disputes and reconsiderations data to track and report on trends and final outcomes to team including conducting outreach for an update on statuses, determinations, and explanationsSkillsAuthorization BuildingUtilization ManagementCritical ThinkingQualificationsYears of experience: 1 yearExperience level: ExperiencedRandstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer:

Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).This posting is open for thirty (30) days. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.