APPLY NOW!
Job title: SCA Appeals Rep I
Company: Anthem
Job description: Description SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At National Government Services (NGS), an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
SCA Appeals Rep I
Location: targeting Harrisburg-PA, Syracuse-NY, Denison-TX, Indianapolis-IN, and South Portland-ME **open to considering a remote arrangement but must be within a commutable distance to an NGS or Anthem office location**
Training: 8-week mandatory training (attendance required)
Hours/shift: Monday-Friday, standard work hours (8 1/2 hour shift)
Pay: pay for this role is determined by the Government, may vary based on location, and is non-negotiable
Harrisburg-PA – $15.14/hr.
Syracuse-NY – $15.00/hr.
Indianapolis-IN – $15.00/hr.
Denison-TX – $15.00/hr.
South Portland-ME – $15.83/hr.
This is an entry-level position in the NGS Appeals Department that reviews, analyzes and processes non-complex pre-service and post-service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (Part A & B) related to clinical and non clinical services, quality of service, and quality of care issues to include executive and regulatory grievances. Primary duties may include, but are not limited to:
- Reviews, analyzes, and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies, and claims events requiring adaptation of written response in clear, understandable language.
- Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.
- The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements – as such, the analyst will strictly follow department guidelines and tools to conduct their reviews.
- Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination.
- Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
- The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations, and other internal departments.
Qualifications
Minimum requirements:
Requires a High school diploma or GED; up to 2 years experience working in grievances and appeals, claims, customer service or any combination of education and/or experience which would provide an equivalent background.
Preferred qualifications:
Familiarity with medical coding and medical terminology, demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company’s internal business processes, and internal local technology.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.
Expected salary: $15.14 per hour
Location: Syracuse, NY
Job date: Sat, 18 Sep 2021 23:10:34 GMT
APPLY NOW!
[ad_2]
