Appeals Representative II

Job Details

The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, and industry standards, along with CMS and state guidelines. This role ensures that all appeals are set up accurately and in a timely manner, supporting the appeal process efficiently.

Essential Functions & Responsibilities

• Receiving and analyzing appeal documentation to determine appropriate actions
• Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents
• Ensure compliance with HIPAA, CMS guidelines, and client instructions and policy standards
• Utilize applicable tools and resources to complete setup

Knowledge & Skills

• Knowledge of Medicare, Medicaid, and commercial insurance guidelines
• Strong attention to detail, time management, and organizational skills
• Excellent written and verbal communication skills
• Knowledge of medical terminology and CPT/ICD codes
• Proficiency with Microsoft applications

Education & Experience

• High school diploma or equivalent
• 1+ years of experience in healthcare, insurance, claim processing, or customer service
• 1+ years working with customers in a fast-paced, deadline-oriented environment
• 1+ years of experience as an Appeals Representative
• Strong technical skills with the ability to work across multiple software systems and work remotely with self-management skills

Pay Range

Pay Range: $20.08 - $30.06 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

About Ceris

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

Benefits

• A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401 K, ROTH 401 K, and paid time off.

Equal Opportunity Employer

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.