Atlanta, GA job vacancy in Medix – Jobs in California

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Job Details
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Company Location :
Job Position :
Atlanta, GA
Job Category :
Jobs in d80ff9f147d06480

Job Description :
Job Title: Remote Claims Representative/Appeals and Grievance Analyst
Client – Bright Health
Pay: $21/hour
Hours – Mon-Fri 8AM-5PM CST
**full time contract to hire**
Location – Atlanta, GA
Job Summary:
The Appeals and Grievances Coordinator description is intended to point out major responsibilities within the role, but it is not limited to these items.
This position will help ensure that Bright Health responds to complaints, grievances, and appeals in a timely, professional, and
customer-focused manner, and completed according to state and federal regulatory standards. This position will be specifically
responsible for monitoring, screening and distributing cases to other team members to ensure accurate and timely working by
the Appeals and Grievances team. This position may also assist in the working of cases, depending on incoming volume, and
other project based worked assigned to the appeals and grievances team.
Monitor all incoming channels, including email, phone, and fax for new Provider Disputes,
updates to current cases, and other inquiries.20%
Review and screen new cases for completeness and timeliness. Communicate with
providers for additional information when necessary. 15%
Enter and handoff new cases to Provider Dispute analysts to be worked once intake process
is complete. 20%
Assist in the review and research of dispute cases. Direct to the appropriate personnel, track
updates and follow up to ensure that resolution has occurred, documentation is complete,
required timeframes are met, and proper written communication of the decision has
Occurred. 15%
Maintain Provider Dispute case files and include necessary information to log incoming
correspondences, tracking dispositions, and maintaining timeliness of resolution as required
by state and federal mandates. 10%
Ensures that all information to members, providers, other parties-to-a- dispute, and other
appropriate persons are accurate, consistent, and customer sensitive. 10%
Prepare member and provider letters 5%
Other duties and responsibilities as assigned. 5%
Bachelor’s degree or equivalent work experience preferred
Three (3) or more years of experience in health plan operations setting required, preferably in Appeals & Grievances, Provider Disputes, Claims or Health Care Customer Service
Professional Competencies:
Detail oriented
Ability to quickly learn and navigate new systems and platforms.
Comfortable being on the phone with external parties including but not limited to members and providers.
Thrive in fast-paced environments and have a passion for extemporary customer service and resolving conflicts.
Self-directed, able to prioritize and takes ownership in projects, cases, and workgroups
About Medix?
Medix is dedicated to positively impacting lives every day. Since 2001, we have made it our mission to be the leading provider of workforce solutions for clients and candidates across the Healthcare, Scientific, and Information Technology industries.
Our dedicated recruiters are here to help you find and secure just the right opportunity. We take the time to learn about you, your skills, your interests, and your career goals, and then match you with the jobs and companies that best suit your needs. Whether you are looking for a contract, contract-to-hire, or direct hire positions, we can help you to find the meaningful and gratifying work that you’ve been looking for. Let Medix be your partner as you move your career forward. Contact us today!
Once you have been a contract employee of Medix for 30 days, you become eligible for our Benefits Program. Should you elect to enroll, there are three levels of medical coverage to choose from, supplemental dental plans and term plans as well as the option to enroll your spouse and/or children. You can select the best combination that best suits your needs.
As a contract employee with Medix, you can choose to enroll in our Benefits Program during your eligibility period and enjoy:
Minimum Essential Coverage (MEC) plan
Two different fixed indemnity plan add-ons
Major Medical Plans, including 1 HSA Plan
Short-term disability
Life and AD&D
Job Types: Full-time, Contract
Salary: $21.00 per hour
Monday to Friday
Application Question(s):
Do you have appeals and grievance, providers disputes, or payment disputes experience?
Do you have any healthcare experience?
Work Location: One location

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