Medical Appeals/Grievances Analyst Job - (baltimore, maryland) in Baltimore, Maryland For Sale

Manages Maryland and District of Columbia member and provider medical appeals, Maryland complaints and grievances. Responsible for member advocate functions. Interacts directly with members, staff, physicians, and others on the telephone to resolve issues. Acts as a resource and documents all information as it relates to medical appeals/complaints and grievances. Assists with the collection of quality improvement information via telephone. Responsible for computer data input, tracking, trending, clerical, survey processing, outbound calls, and correspondence.
Qualifications
Education: Associates degree, or high school graduation/equivalent plus an equivalent combination of education and related experience; Bachelors degree preferred.
EXPERIENCE: 2 years customer service experience in a managed care or social service setting. Medical appeals processing, medical billing claims auditing, and COB experience a plus.
LICENSE/CERT/REG: No special certification, registration or license required.
Skills: Ability to type 40 words per minute. Filing skills. Knowledge of claims processing and medical billing. Knowledge of managed care/healthcare industry preferred. Ability to process complex business rules simultaneously to render decisions. Attention to detail. Logical reasoning and deduction skills for error and problem resolution. Working knowledge of various computer software applications, including Microsoft Word and Excel and medical software. Excellent verbal and written communication skills.
Facility Location: White Marsh
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