Legal Appeals Research Specialist I

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Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.Arkansas Blue Cross is only seeking applicants for remote positions from the following states:Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

Job SummaryLegal Appeals Researcher Specialist assists with organizing and coordinating legal appeals and complaints by efficiently and accurately preparing reports, researching, document gathering, handling inquiries and coordinating work for professional staff.

Requirements

EDUCATION

High school diploma or equivalent.

EXPERIENCE
Minimum three (3) years' claims processing, claims research experience, or customer service experience required.
Familiarity with CPT, ICD-10 and Medical Terminology.

ESSENTIAL SKILLS & ABILITIES
Microsoft Office Suite
ICD 10 and CPT Coding
Medical Terminology
Medical Claims Processing
Researching
Confidentiality
Professionalism Judgement
Interpersonal Communication
Multitasking
Highly Organized
Detail-Oriented
Problem Solving
Oral & Written Communication
Self-Motivated Team Player
Ability to work independently.

SkillsAbility to work independently (Inactive), Detail-Oriented, Group Problem Solving, Interpersonal Relationships, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Oral Communications

ResponsibilitiesCoordinates adjustment activities with adjustments, claims processing area, medical directors, attorneys and professional staff., Monitors system queue and provides daily reporting of appeals status., Performs other duties as assigned, Requests and reviews medical records related to appeals research, as requested., Researches complaints utilizing multiple systems and resources. Prepares documentation for appeals filing ensuring timely responses.

Certifications

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment TypeRegular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.