Appeals Representative II

The Appeals Representative is responsible for addressing provider inquiries and appeals via email, fax, telephone, or written correspondence ensuring adherence to client policy, industry standards along with CMS and state guidelines as well as client instructions.

Requirements

• Reviews, analyzes, and completes appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication
• Ability to appropriately interpret provider appeals and apply analytical thinking skills
• Ability to interpret client policy and CMS guidelines as it relates to reviews done by CERiS such as itemized bill
• Timely completion of appeals
• Prior knowledge of inpatient and outpatient hospital revenue cycle required
• Excellent written and verbal communication skills
• Contract interpretation, medical terminology and coding knowledge
• Proficiency with Microsoft applications
• High school diploma or equivalent
• 3+ years of healthcare revenue cycle experience (collections, appeals, denials management, etc)
• 2+ years working with customers in a fast‐paced, deadline‐oriented environment
• 2+ years experience as an Appeals Representative

Benefits

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• Paid Time Off