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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.
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