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Appeals Specialist II
MedReview —Remote
- $50,000 - $55,000 a year
- Full-time
- Remote
- Research
- Mid-level
- Microsoft Office
- Commuter assistance
- Health insurance
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Support Specialist
Order.co —Remote
- $24 - $27 an hour
- Full-time
- Remote
- Continuous improvement
- 1 year
- Communication skills
- Health insurance
- Dental insurance
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14d
Customer Support Specialist - USA
Railbookers Group —Remote
- Weekends as needed
- Remote
- Microsoft Excel
- Microsoft Outlook
- Sales
- Health savings account
- Disability insurance
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Complaint Support Specialist
Noctrix Health —Remote
- $55,000 - $75,000 a year
- Full-time
- Mid-level
- Analysis skills
- Bachelor's degree
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Healthcare Quality Management Specialist (Remote)
MRIoA —Remote
- Full-time
- Remote
- Microsoft Word
- Background check
- 5 years
- Paid holidays
- Health insurance
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Docketing Specialist
Fisher & Phillips LLP —Remote
- $39 - $50 an hour
- Full-time
- Remote
- 5 years
- Organizational skills
- Senior level
- Profit sharing
- Paid holidays
Escalation Specialist
Lake Appliance Repair —Remote
- Full-time
- Local
- Mid-level
- High school diploma or GED
- Paid holidays
- Paid time off
Expedited Appeals Specialist (Remote)
EmblemHealth —New York, NY
- $48,600 - $83,160 a year
- Weekends as needed
- Remote
- Microsoft Outlook
- Research
- Mid-level
6d
Special Education Complaint Investigation Specialist
West Bay Collaborative —Providence, RI
- Writing skills
- Mid-level
- Master's degree
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CS Tech Support Specialist I (***)
Moda Health —Milwaukie, OR
- $21.30 - $23.96 an hour
- Weekends as needed
- Microsoft Excel
- Computer literacy
- Writing skills
- Paid holidays
- Health insurance
Quick Apply
Intake Substance Use Dependency Professional Trainee (SUDPT)
Discover Recovery Treatment Center —Long Beach, WA
- $40,000 - $65,000 a year
- Weekends as needed
- CPR Certification
- Addiction Medicine
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
Therapeutic Treatment Home Licensing Specialist
Presbyterian Hospitality House —Juneau, AK
- Full-time
- Mid-level
- Residential
- Bachelor's degree
- Relocation assistance
- Tuition reimbursement
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Family Specialist (Madison County)
Together for Youth —Madison, NY
- $23.08 - $25.48 an hour
- Weekends as needed
- Bilingual
- Clean driving record
- Up to 50% travel
- Mileage reimbursement
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Quality Assurance Specialist
RION Inc —Rochester, MN
- $80,000 - $110,000 a year
- Full-time
- Laboratory experience
- Bachelor's degree
- Children
- Health savings account
- Paid holidays
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7d
Card Services Specialist
University of Hawaii FCU —Honolulu, HI
- $37,000 - $46,000 a year
- Weekends as needed
- Computer literacy
- Basic math
- English
- Commuter assistance
- AD&D insurance
Quick Apply
5d
Claims Specialist
Maddox Industrial Transformer —Moscow, ID
- $88,000 - $96,000 a year
- Full-time
- Google Workspace
- Military
- Mid-level
Quick Apply
Customer Account Specialist
Magris Talc —Three Forks, MT
- $47,137 - $58,921 a year
- Full-time
- 5 years
- Mid-level
- Associate's degree
Milieu Specialist
Walker, Inc. —Needham, MA
- $22 - $23 an hour
- Weekends as needed
- Background check
- Ability to walk for extended periods
- 5 years
- Health insurance
- Dental insurance
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Business Development Specialist I
Interstate Batteries —Waipahu, HI
- $60,000 - $65,000 a year
- Weekends as needed
- Mid-level
- Microsoft Office
- Ability to lift 50 pounds
- Health insurance
- Dental insurance
Quick Apply
Finance Program Specialist I
South Dakota State Government —Sioux Falls, SD
- $28.54 an hour
- Online Application
- CPA
- Office
- Bachelor's degree
- Paid holidays
- Health insurance

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Appeals Specialist II

MedReview -
Remote

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Job Details

Full-time
$50,000 - $55,000 a year

Benefits

Commuter assistance
Health insurance
Dental insurance
Flexible spending account
Paid time off
Vision insurance
401(k) matching

Qualifications

Computer operation
Pricing
Research
Microsoft Office

Full Job Description

Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.
Under the direction of the Appeals Department leaders, the Appeals Coordinator level II team member will assist Appeals leadership with daily administrative work within the department.
The Appeals Specialist level II performs research, investigation, and analysis of appeals, grievances, and other types of complaints filed by providers and clients to administer timely resolution. Responsible for all aspects of nonclinical appeals and inquiries

Responsibilities
This list does not represent all responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of the department and NYCHSRO/MedReview in general.

Prepare and disseminate case file for External Reviews and/or State Fair Hearing
Manage and monitor all appeals from Non-Participating providers
Independently prepare well written, customized responses to all provider inquiries/complaints that appropriately and completely address the complainant’s issues and are structurally accurate.
Ensure timely review, research, and resolution of appeals, grievances, and complaints within guidelines. Ensures that all complaints are handled and resolved in compliance with timeliness requirements, and at the highest standards for accuracy
Consults with managers on problem cases and interfaces with clinical supervisors, account managers, and other personnel in resolving health plan requests or provider inquiries
Log and track grievances, appeals, and other types of complaints as needed.
Review and determine outcome of appeal/grievance, either independently or in conjunction with clinical appeal staff.
Consults with subject matter experts and resources available within organization to assist in appeal and complaint resolution.
Make critical decisions regarding research and investigation to appropriately resolve all inquiries
Serve as a liaison to Appeal Coordinator providing guidance and expertise to ensure timely resolution of cases
Other duties and responsibilities as assigned

Qualifications:

Associates Degree. Additional years of related experience may be used in place of education requirements
3+ years’ experience working in the health care industry
Experience in inpatient claims, DRG and High-Cost Outlier claims preferred
Experience in DRG Pricing using WebStrat
Knowledge in claim payment methodology
Good MS Office skills. Particularly Excel
Excellent problem solving and analytical skills required
Ability to manage priorities in a complex environment.
Excellent organization and time management skills required
Excellent written and verbal communication skills
Takes initiative to proactively identify and solve problems
Ability to meet strict, time sensitive deadlines
Ability to cope well with ambiguity and stressful situations
Must show patience and the ability to remain calm under pressure in an atmosphere of frequent interruptions

Remote Work Requirements

High speed internet (100 Mbps per person recommended) with secured WIFI.
A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
Must be able to sit and use a computer keyboard for extended periods of time.

Benefits and perks include:

Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
401(k) with Employer Match - Join the team and we will invest in your future
Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.

Salary Range: $50,000- $55,000/ annually.

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Refine Your Search

complaint specialist jobs

Appeals Specialist II

Support Specialist

Customer Support Specialist - USA

Complaint Support Specialist

Healthcare Quality Management Specialist (Remote)

Docketing Specialist

Escalation Specialist

Expedited Appeals Specialist (Remote)

Special Education Complaint Investigation Specialist

CS Tech Support Specialist I (***)

Intake Substance Use Dependency Professional Trainee (SUDPT)

Therapeutic Treatment Home Licensing Specialist

Family Specialist (Madison County)

Quality Assurance Specialist

Card Services Specialist

Claims Specialist

Customer Account Specialist

Milieu Specialist

Business Development Specialist I

Finance Program Specialist I

I want to receive the latest job alert for complaint specialist

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