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    HomeVacanciesMedical Data Entry Clerk- FULLY REMOTE

    Medical Data Entry Clerk- FULLY REMOTE

     

    Lensa is a career site that helps job seekers find great jobs in the US. We are
    not a staffing firm or agency. Lensa does not hire directly for these jobs, but
    promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad
    agencies, and marketing partners. Lensa partners with DirectEmployers to promote
    this job for TEKsystems.

    TekSystems is currently hiring for a FULLY REMOTE Medical Data Entry Specialist!

    MUST HAVE: Must be on EST time zone to be considered, Must have any healthcare
    administrative, medical billing, claims, grievances, appeals experience, or
    something related!

    Description

    REMOTE

    SHIFT: Mon – Friday, 9am – 5pm EST

    Position Overview

    The client backlog of 10,000 appeals and grievances so these Data Entry Reps
    will be filtering through the appeals and take the following actions….

    Summary Of Position

    Respond to written/verbal grievances, complaints, appeals and disputes submitted
    by members and providers in accordance

    with NCQA, CMS, State and other regulations.

    Process appeals and grievances to facilitate the accurate administration of
    benefits and clinical policy; ensure compliance of

    the appeal and grievance process with all regulatory requirements and NCQA
    standards.

    Work as an effective interface between internal and external customers

    Maintain good member and provider relations

    Principal Accountabilities

    Comprehensively review and evaluate appeal and grievance requests to identify
    and classify member and provider

    appeals.

    Determine eligibility, benefits, and prior activity related to the claims,
    payment or service in question.

    Provide written acknowledgment of member and provider correspondence.

    Responsible for making verbal contact with the member or authorized
    representative during the research process to

    further clarify, as needed, the member’s complaint or appeal.

    Conduct thorough investigations of all member and provider correspondence by
    analyzing all the issues involved and

    obtaining responses and information from internal and external entities.

    Serve as liaison with EmblemHealth departments, delegated entities, medical
    groups and network physicians to

    ensure timely resolution of cases.

    Research appeal files for completeness and accuracy and investigate
    deficiencies. Consult with internal areas as

    required (such as the Legal Department) to clarify legal ramifications around
    complex appeals.

    Follow-up with responsible departments and delegated entities to ensure
    compliance.

    Accurately and completely prepare cases for medical and administrative review
    detailing the findings of their

    investigation for consideration in the plan’s determination.

    Monitor daily and weekly pending reports and personal worklists, ensuring
    internal & regulatory timeframes are met.

    Responsible for monitoring the effectuation of all resolution/outcomes resulting
    from internal appeals as well as all

    appeals reviewed through the IRE.

    Identify areas of potential improvement and provide feedback and recommendations
    to management on issue

    resolution, quality improvement, network contracting, policies and procedures,
    administrative costs, cost saving

    opportunities, best practices, and performance issues.

    Prepare written responses to all member and provider correspondence that
    appropriately address each complainant’s

    issues and are structurally accurate.

    Ensure documentation requirements are met: create and document service requests
    to track and resolve issues;

    Additional Skills & Qualifications

    Relevant Work Experience, Knowledge, Skills, and Abilities

    3+ years of related professional work experience.

    Prior health industry and/or compliance work experience.

    Additional years of experience/training may be considered in lieu of educational
    requirements.

    Excellent verbal and written communications skills.

    Experience in a managed care/compliance environment.

    Ability to comprehend and produce grammatically accurate, error-free business
    correspondence.

    Customer service experience.

    Proficiency in MS Office applications (especially word processing, and
    database/spreadsheet).

    Excellent product knowledge.

    Excellent problem solving and analytical skills.

    Ability to work under pressure and deliver complete, accurate, and timely
    results.

    Excellent organization and time management skills.

    Pay and Benefits

    The pay range for this position is $20.00 – $20.00/hr.

    Requirements

    Eligibility requirements apply to some benefits and may depend on your job
    classification and length of employment. Benefits are subject to change and may
    be subject to specific elections, plan, or program terms. If eligible, the
    benefits available for this temporary role may include the following:

    * Medical, dental & vision
    * Critical Illness, Accident, and Hospital
    * 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
    * Life Insurance (Voluntary Life & AD&D for the employee and dependents)
    * Short and long-term disability
    * Health Spending Account (HSA)
    * Transportation benefits
    * Employee Assistance Program
    * Time Off/Leave (PTO, Vacation or Sick Leave)

    Workplace Type

    This is a fully remote position.

    Application Deadline

    This position is anticipated to close on Jul 10, 2025.

    h4>About TEKsystems:

    We’re partners in transformation. We help clients activate ideas and solutions
    to take advantage of a new world of opportunity. We are a team of 80,000 strong,
    working with over 6,000 clients, including 80% of the Fortune 500, across North
    America, Europe and Asia. As an industry leader in Full-Stack Technology
    Services, Talent Services, and real-world application, we work with progressive
    leaders to drive change. That’s the power of true partnership. TEKsystems is an
    Allegis Group company.

    The company is an equal opportunity employer and will consider all applications
    without regards to race, sex, age, color, religion, national origin, veteran
    status, disability, sexual orientation, gender identity, genetic information or
    any characteristic protected by law.

    About TEKsystems And TEKsystems Global Services

    We’re a leading provider of business and technology services. We accelerate
    business transformation for our customers. Our expertise in strategy, design,
    execution and operations unlocks business value through a range of solutions.
    We’re a team of 80,000 strong, working with over 6,000 customers, including 80%
    of the Fortune 500 across North America, Europe and Asia, who partner with us
    for our scale, full-stack capabilities and speed. We’re strategic thinkers,
    hands-on collaborators, helping customers capitalize on change and master the
    momentum of technology. We’re building tomorrow by delivering business outcomes
    and making positive impacts in our global communities. TEKsystems and TEKsystems
    Global Services are Allegis Group companies. Learn more at TEKsystems.com.

    The company is an equal opportunity employer and will consider all applications
    without regard to race, sex, age, color, religion, national origin, veteran
    status, disability, sexual orientation, gender identity, genetic information or
    any characteristic protected by law.

    If you have questions about this posting, please contact support@lensa.com