Review & Appeals Specialist I

About the role

The Review & Appeals Specialist I works as an integral part of the Review & Appeals team to review disciplinary notifications, exception-to-policy requests, re-establishment requests, and complaints. The role ensures the accuracy and integrity of case data, supports investigations, and maintains effective communication with internal and external stakeholders.

Responsibilities

• Review incoming disciplinary notifications from internal and external entities, exception-to-policy requests, re-establishment requests, and complaints.
• Identify issues requiring additional investigation, validate discrepancies, and ensure appropriate follow-up.
• Obtain and organize required documentation for case consideration.
• Document case-related information and communications in established databases and systems.
• Maintain accuracy and integrity of review and appeals data, correspondence, recommendations, and related applications.
• Verify licensure status with relevant state licensing boards.
• Analyze documentation and prepare summary findings in accordance with established timeframes and policies.
• Correspond professionally with Physician Assistants and internal and external stakeholders.
• Refer findings to management or higher-level specialists as appropriate.
• Prepare cases for external reporting to FSMB and associated licensing boards.
• Maintain working knowledge of NCCPA policies, procedures, operational guidelines, and audit tools.
• Build and maintain professional rapport with internal and external partners.
• Participate in interdepartmental meetings and complete assigned projects.
• Meet departmental accuracy standards and turnaround times for case processing.
• Support UAT and other testing activities as needed.

Requirements

• An associate degree, preferably in Business, Legal Studies, Healthcare, or related field (or equivalent experience).
• Working knowledge of Microsoft Office applications, including Word, Outlook, Excel, PowerPoint, and Adobe Acrobat.
• Ability to read and interpret organizational policies and job-specific documentation.
• Strong analytical and problem-solving skills.
• Ability to manage competing priorities and meet established timeframes.
• Excellent written and verbal communication skills with strong attention to confidentiality.
• Ability to provide exceptional customer service to internal and external stakeholders.

Qualifications

• Highest level of proficiency in Microsoft Office applications.
• Experience with healthcare or legal environments preferred.
• Strong attention to detail and organizational skills.
• Ability to work independently and manage multiple tasks simultaneously.
• Exceptional communication skills, both written and verbal.
• Ability to handle sensitive and confidential information with discretion.

Skills

• Strong analytical and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to manage competing priorities and meet established timeframes.
• Attention to detail and organizational skills.
• Professional judgment and discretion.
• Collaborative and proactive mindset.

Benefits

NCCPA offers a competitive compensation package, including health insurance, retirement plans, and paid time off. The hybrid work environment allows for flexibility and a healthy work-life balance.

Pay

Salary range for this position is $50,000 - $60,000 annually, commensurate with experience.

Schedule

This role is a hybrid position, combining remote and in-office work. Employees may work from home up to 50% of the time, with the remaining time spent at NCCPA headquarters in Johns Creek, Georgia.