Appeals Representative

Category: MS Type: Full-Time SCA Description: TerraHealth, a division of THI, is seeking an Appeals Representative for a position in Williamsport, Pennsylvania. TerraHealth is a leading government Health Care Services support company. We operate in 32 states with over 400 employees.

JOB DESCRIPTION:
Under general supervision, this position may include any of the following activities: research, review, and respond to appeal requests in accordance with documented and approved procedures; research and answer all telephone and written inquires received from insurers, employers, attorneys, Treasury Department, and Medicare contractors. Repond to complaints utilizing departmental policies and procedures.
Requirements: High School diploma or GED certification is required.
One (1) to three (3) years of research skills in reading and interpreting information and analytical decision making skills. The individual needs to have experience reading, researching, and applying multiple procedures and guidelines, and making an independent decision based on those guidelines.
Ability to work independently
Experience navigating through multiple on-line procedures.
Prior experience in a "change-based" atmosphere. We experience continual changes within our processing system and procedures. The individual needs to be able to adapt to those changes when processing appeals.
Experience in Windows-based processing system is helpful.
Correspondence experience is helpful. Letter system is based on pre-established paragraphs and letter shells with fill-ins to make the letter unique ot the appeal. There are instances when editing is necessary. Appeal letters are very detailed and require an understanding of building a letter with the required components.
Prior experience in a production atmosphere where the individual is familiar with the concept of completing an appeal case within a given amount of time to meet a production standard or processing expectation.
Quality-oriented.
Prior experience with multiple tasks and keeping pending work organized. Some appeal case work is completed in stages and the individual needs always be aware of the pending case work and pending adjustment to ensure timely processing.
Sequential personalities, rather than random, work best in appeals. This personality type is more prone to be successful since there is an established workflow to be followed, rather than gravitating to a tangent thought process, which may clutter or slow down the decision-making process on an appeal case.
Prior medical or insurance experience, along with the above-referenced work experience is beneficial, since these individuals usually have worked in a similar environment.
Location Williamsport,PA Minimum Experience (yrs): 1 Required Education: High School Diploma Salary: Open