Health Advocate Appeals Specialist
West Corporation

Job Info

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For this opening we will consider candidates from the following locations: ,PA,United States |

Are you looking for a meaningful job where the work you do truly makes a difference in people's lives every day?

Health Advocate is currently seeking an Appeals Specialist for our site in Plymouth Meeting, PA. Our next Appeals Specialist should have a great eye for detail, possess strong communication and negotiation skills, and have in-depth knowledge of healthcare insurance and the appeals process. Great organizational skills, a strong understanding of professional customer service, and the ability to form and maintain close working relationships with business partners are key to success in this role as well. If this sounds like you, then we would love to speak with you!

We offer great benefits! The benefits package for this position includes very generous Paid Time Off, paid holiday policy, tuition reimbursement and a 401(k) with a match. Health Advocate has an Employee Assistance Program, wellness programs and employee activities to support employees with various goals.

The Appeals Specialist is responsible for:

• Providing appeals assistance for members with denied medical treatment or services claims, which includes advocating for members in the appeals process

• Negotiating fees on behalf of the member

• Researching denied claims ensuring proper coding

• Educating members on the components of their benefit plan coverage

Additional job responsibilities include:

• Research billing issues to determine the possible cause of the error ensuring to assist with claims re-submission as required to correct the issue

• Establish and maintain a network of key contacts within insurance carriers, federal and state offices, and the health insurance industry

• Educate members on insurance plan provisions ensuring they have a full understanding of their plan

• Research and evaluate appeals issues to determine the possible cause of the error ensuring to assist the client throughout the appeal process

• Document all appeals issues thoroughly maintaining department files and appropriate databases

• Assist in monitoring issue trends, escalating such trends to supervisor to determine appropriate actions necessary to eliminate future occurrences and improve service levels

Mental and Physical Requirements

• This position will be exposed mainly to an indoor office environment and will be expected to work near or around computers, telephones, and printers

• The nature of the work in this position is sedentary and the incumbent will be sitting most of the time

• Essential physical functions of the job include typing, grasping, pulling hand over hand, and repetitive motions to utilize general computer software/hardware continuously throughout the work day

• Essential mental functions of this position include concentrating on tasks, reading information, and verbal/written communication to others continuously throughout the work day

Qualifications - Internal

Education

• High School Degree or GED required

• Associate degree from an accredited college or university with major course work in business administration, liberal arts, public health, healthcare management, or a related field preferred

Experience

• Minimum of five years, healthcare or carrier customer service, healthcare, appeals, or a related experience required

• Minimum 1-year claims experience preferred

Other

• Basic Knowledge of MS Word and Excel required

• Must score acceptably on job related testing

• Knowledge of the following is preferred:

• COBRA

• Medicare A, B, MediGap, Supplement plans, Medicare Advantage, Medicare Part D plans

• High deductible health plans including Health Reimbursement Accounts (HRAs) and Health Saving Accounts (HSAs)

• Flex Spending Accounts (FSA), including limited FSAs

• Coordination of benefits and which plan is primary - simple and complex cases (commercial plans, Medicare plans)

• Summary Plan Documents (SPDs) and Certificates of Coverage (COCs)

• Government programs, resources and legislation and mandates including but not limited to Affordable Care Act, FMLA, Medicaid, CHIP

• Group Health Plans (fully insured and self-insured)

• Pharmacy benefits including injectable medications

• Individual Health plans and Exchanges plans

• Strong communication skills and phone etiquette

https://vimeo.com/386733264/eb447da080

Equal Opportunity Employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race. color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age, pregnancy, genetic information or any other consideration prohibited by law or contract.

Job Type: Full-time

Company's website:

• https://www.healthadvocate.com/site/

Company's Facebook page:

• https://www.facebook.com/healthadvocateinc/

About US:

Health Advocate is the nation's leading provider of health advocacy, navigation, well-being and integrated benefits programs. For nearly 20 years, Health Advocate has provided expert support to help our members navigate the complexities of healthcare and achieve the best possible health and well-being. Our solutions leverage a unique combination of best-in-class, personalized support with powerful predictive data analytics and a proprietary technology platform to address nearly every clinical, administrative, wellness or behavioral health need. Whether facing common issues or an unprecedented challenge like COVID-19, our team of highly trained, compassionate experts work together to go above and beyond expectations, making healthcare easier for our members and ensuring they get the care they need.

Silver winner - Best in Biz Award 2020
Most Customer-Friendly Company of the Year

Silver winner - Stevie® Award 2020
Healthcare Customer Service Department of the Year

Bronze winner - Stevie® Award 2020
Most Valuable Response by a Customer Service Team

ABOUT US

Connecting people with each other and the right information is mission critical. Intrado develops innovative cloud-based technology to make it easier, more effective and more efficient to make the right connections. Our solutions put people in sync with each other and the right information, so they gain the insight needed to reach better decisions on the issues that matter most. We do it with a laser focus on reliability.

Intrado is a leading provider of technology-driven, communication services, serving Fortune 1000 companies and other clients in a variety of industries, including telecommunications, retail, financial services, public safety, technology and healthcare. For more than 30 years, we have been leading the way in hosted and cloud-based solutions.

Our solutions connect people with each other and the information needed to gain insights for better decisions on the issues that matter most - Information to Insight.

Intrado has sales and/or operations in the United States, Canada, Europe, the Middle East, Asia Pacific, Latin and South America and is an Equal Opportunity Employer - Veterans/Disabled and Other Protected Categories.

ABOUT THE TEAM

Health Advocate is the nation's leading provider of health advocacy, navigation, well-being and integrated benefits programs. For nearly 20 years, Health Advocate has provided expert support to help our members navigate the complexities of healthcare and achieve the best possible health and well-being. Our solutions leverage a unique combination of best-in-class, personalized support with powerful predictive data analytics and a proprietary technology platform to address nearly every clinical, administrative, wellness or behavioral health need. Whether facing common issues or an unprecedented challenge like COVID-19, our team of highly trained, compassionate experts work together to go above and beyond expectations, making healthcare easier for our members and ensuring they get the care they need.

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