Appeals Specialist

Remote

Full Time

Student (High School)

Overview:

J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as an employee-centered healthcare management consulting company. Our team of 260 employees focuses on providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance, policy, and clinical expertise. Our team is experienced in program, payment, provider, and patient integrity as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels.

J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to empower our employees to do great things for the benefit of those that need it most. The J29 mission supports not only our health and human service programs, but also the philanthropy efforts of our team. We are proud to continue our support to non-profit groups with critical missions as J29 continues to grow.

Position Purpose:
Performs moderately complex (journey-level) appeals work. Researches and responds to inquiries from providers, suppliers, beneficiaries, health plans, or others involved in the appeals/dispute process. May conduct phone calls with appellants for the purpose of scheduling phone discussions with the company decision maker. Works under moderate supervision, with moderate latitude for the use of initiative and independent judgement.

Essential Responsibilities:

Provides customer service and researches and responds to inquiries received by phone, fax, mail, or email timely and accurately.
Interprets requests and determines appropriate response or course of action to bring to resolution with minimal assistance.
Conducts research using online federal regulations, review Medicare and Medicaid policy and guidelines to complete an accurate and well-supported decision.

Screens receipts to determine the issue addressed in the correspondence and address timely which may involve forwarding cases to the appropriate person or entity timely.
Logs receipts and enters into database.

Trends receipts/issues and schedules coordination meetings as required.
Prepares and sends professionally worded letters, emails or faxes.
May initiate, schedule and coordinate reconsideration phone discussions between suppliers and decision makers by coordinating with appellants on schedule adherence and reschedule as needed, reviewing decision maker calendars to ensure phone discussions are held as scheduled with minimal interruptions, and validate additional documents submitted by appellant and that verbal testimonies are received and images are uploaded into appropriate system.

Participates in special projects and performs other duties as assigned.

Minimum Qualifications

Education

High School Diploma or equivalent

Experience

Three (3) years of general office experience
- College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)
One (1) year of Medicare Qualified Independent Contractor appeals experience OR One (1) year of professional business writing experience in the healthcare, customer service or legal industries
Experience directly relevant to the specific task order or project, preferred

Knowledge, Skills and Abilities

Working Knowledge of

Research techniques
Medicare appeals program
Medical terminology
Applicable systems and applications
Applicable laws, rules and regulations

Proficient Skill in

Preparing correspondence/documents using correct spelling, grammar and punctuation; proofreading and reviewing documents for clarity and consistency
Prioritizing and organizing work assignments
The use of personal computers and applicable programs, applications and systems

Some Skill in

Researching, analyzing and interpreting policies and state and federal laws and regulations

Ability to

Meet production and quality standards
Multitask and meet deadlines
Exercise logic and reasoning to define problems, establish facts and draw valid conclusions
Make decisions that support business objectives and goals
Identify and resolve problems or refer issues appropriately
Communicate effectively verbally and in writing
Adapt to the needs of internal and external customers
Show integrity and ethical behavior; respect confidentiality, business ethics and organizational standards
Assures compliance with company policies, procedures, and guidelines including cybersecurity, regulatory, contractual and accreditation entities

J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.

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J29 is a healthcare management consulting company that prides itself on delivering across an array of core competencies that include clinical, policy, and data expertise at the patient, provider, and insurance plan levels.

Appeals Specialist

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