Appeals Representative II

Essential Functions & Responsibilities

• Reviews, analyzes, and completes appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication.
• Ability to appropriately interpret provider appeals and apply analytical thinking skills.
• Ability to interpret client policy and CMS guidelines as it relates to reviews done by CERiS such as itemized bill.
• Utilize applicable tools and resources to complete appeals.
• Timely completion of appeals.

Knowledge & Skills

• Prior knowledge of inpatient and outpatient hospital revenue cycle required.
• Excellent written and verbal communication skills.
• Contract interpretation, medical terminology and coding knowledge.
• Proficiency with Microsoft applications.

Education & Experience

• High school diploma or equivalent.
• 3+ years of healthcare revenue cycle experience (collections, appeals, denials management, etc).
• 2+ years working with customers in a fast‐paced, deadline‐oriented environment.
• 2+ years experience as an Appeals Representative.
• Strong attention to detail, organizational and time management skills with the ability to interpret, research and identify core issues.
• Strong customer focus, analytical and decision making skills.
• Strong technical skills with the ability to work across multiple software systems and comfortable working remote out of your home.

Pay

Pay Range: $18.80 - $30.34 per hour

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, 401K, ROTH 401K, and paid time off.

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.