Three Point Solutions
Appeals Specialist III
Three Point Solutions, Baltimore, Maryland, United States, 21276
Job Title: Appeals Specialist III / Member Service Rep III
Client: Health Care Insurance
Duration: 4 Months
Location: Baltimore, MD 21224
(Mandatory- 100% remote however the resource must reside in District of Columbia, Maryland, Virginia(DMV)
Job Title: Appeals Specialist III
Responsibilities:Assist Manager, Supervisors, and Business Analysts with projects, quality audits, and operationsAnalyze appeals correspondence, determine next steps, and expedite processingServe as subject matter expert, providing coverage for complex casesPrioritize, research, and analyze information for initial inquiriesLead a team in identifying risks and trends in processesResearch high-profile cases and communicate with governmental agenciesDevelop accurate professional written communications and verbal interactionsPresent and discuss compliance issues, providing recommendationsResearch contractual benefits, limitations, and exclusionsAssist medical staff with appeals and reconsiderationsAct as liaison for time-sensitive or escalated tasksProvide training and mentorship to entry-level associatesDesign and deliver training programs for internal customersSupport committees and special projectsTop 5 Required Skills:MD Medicaid appeal and grievance experience in managed careData entry skillsOrganizational skillsMedical terminologyKnowledge of systems (Hyland OnBase, Health Rules, Care Manager)
Qualifications:
Education Level:
High School DiplomaExperience:
5 years in managed care, health care, or insurance payor environment3 years in Clinical Appeals and Analysis Unit2 years as Appeals Specialist II
Preferred Qualifications:
College DegreeKnowledge of client systems, Member/Provider Service, Claims, or Care ManagementLeadership experience
#ZR
Client: Health Care Insurance
Duration: 4 Months
Location: Baltimore, MD 21224
(Mandatory- 100% remote however the resource must reside in District of Columbia, Maryland, Virginia(DMV)
Job Title: Appeals Specialist III
Responsibilities:Assist Manager, Supervisors, and Business Analysts with projects, quality audits, and operationsAnalyze appeals correspondence, determine next steps, and expedite processingServe as subject matter expert, providing coverage for complex casesPrioritize, research, and analyze information for initial inquiriesLead a team in identifying risks and trends in processesResearch high-profile cases and communicate with governmental agenciesDevelop accurate professional written communications and verbal interactionsPresent and discuss compliance issues, providing recommendationsResearch contractual benefits, limitations, and exclusionsAssist medical staff with appeals and reconsiderationsAct as liaison for time-sensitive or escalated tasksProvide training and mentorship to entry-level associatesDesign and deliver training programs for internal customersSupport committees and special projectsTop 5 Required Skills:MD Medicaid appeal and grievance experience in managed careData entry skillsOrganizational skillsMedical terminologyKnowledge of systems (Hyland OnBase, Health Rules, Care Manager)
Qualifications:
Education Level:
High School DiplomaExperience:
5 years in managed care, health care, or insurance payor environment3 years in Clinical Appeals and Analysis Unit2 years as Appeals Specialist II
Preferred Qualifications:
College DegreeKnowledge of client systems, Member/Provider Service, Claims, or Care ManagementLeadership experience
#ZR