Clinical Appeals Specialist-Remote

Date Posted: 10/11/2021

Equity Staffing is looking for a Remote Appeals Specialist. This position is with a Fortune 100 organization. Our client serves more than 85 million people and has a reputation for bold ideas. If you enjoy working with energetic people in a collaborative environment, we want to speak with you!

Primary Responsibilities:
Set up Appeals (includes receive, analyze, evaluate, and track appeal documents; follow inquiries and complaints through final resolution) by established processes and procedures, and within established time standards.
Provide quality written responses (applying the appropriate composition, grammar, punctuation, and spelling) to appeals, inquiries, negotiations, and complaints within established time standards.
Create, compose, and maintain appeal response templates, and routinely review to update language, and apply and coordinate such updates and changes under the guidance of the Director of the Resolution & Appeals Division and other Management as appropriate.
Coordinate with Appeal Department Management and Senior Specialist, as required, to compose appeal responses.
Communicate/interact with clients and providers (telephone, email, other written correspondence, participate in meetings) as required.
Perform research and provide documentation for Appeal matters as requested within required time frames
Update claims (logs, dates, processes, documentation) in Equian system following company standards within established time standards
Update and maintain the accuracy of the Appeal section of the Client Matrix for each client to ensure appeal response requirements (such as timelines, policies, and procedures) are available for reference to set up claim appeals when received
Perform peer QA of appeal responses as-needed
Participate in department and company meetings as requested
Participate on committees and special projects (as assigned or required) to ensure consistency of the claim review from the initial report through the appeal process
Meet time, quality, and customer satisfaction standards
Complete special projects related to appeals as assigned, within required time standards
Understand, maintain, and apply HIPAA, confidentiality, and privacy standards to assigned work, as well as ERISA and fraud, waste and abuse laws

Required Qualifications:
Computer Skills.
Experience with Microsoft Office suite of tools.
Communication Skills both verbal and written.
1-2 years claim or Appeals Experience
Ability to work with others.
Good Grammar

Remote/Onsite: Remote

Equity Staffing Group is one of the fastest growing Native American owned staffing companies in the United States. We are a certified Minority Business Enterprise (MBE) by the National Minority Supplier Development Council (NMSDC) and the Rocky Mountain Minority Supplier Development Council (RMMSDC).

Equity Staffing Group is an Equal Employment Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Equity Staffing Group will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

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"I was so impressed with the outstanding service that Equity Staffing provided in placing me in my current position.  I wasn’t sure I would be a good candidate for this position, but my recruiter and Equity’s Account Manager took the time to go over the job description and how my experience and skill set would fit in perfectly with this job assignment.  I am glad I took their advice, because I am now on contract with a great company working with a professional staff and learning how to support a management team in an industry I have never worked in before.” 

Lisa M.

Denver, CO

“I’ve been an IT contractor for 9 years, and in that time I’ve been exposed to numerous IT staffing firms and consulting agencies, big and small.  Equity impressed me immediately.  My recruiters quickly and efficiently connected me with a great tech company whose needs in both personality and tech proficiency matched my wheelhouse in addition to a healthy dose of career progressing tech challenges.  And a 12 minute drive from my house no less.  That’s huge for me.  They were willing to meet face to face before the client company interview which, in my experience, is critical to the staffing firm / contractor relationship.  Equity is organized, modern, and professional, and my recruiters were very pleasant to work with, responsive, and generous with their time.  I’m grateful for all they’ve done for me.”

Christopher S.

Minneapolis, MN

“Working as a consultant for Equity Staffing Group has been a wonderful experience.  My recruiter was a true professional throughout the entire process.  Equity separates itself from other staffing companies I have worked with in past because they provided wonderful customer service, they had benefits offerings,  the onboarding was easy and efficient but best of all they followed up with me prior to my assignment ending and found my next assignment shortly afterward.  I highly recommend the professionals at Equity Staffing Group!”

Tamika B.

Atlanta, GA