BCforward is currently seeking a highly motivated Appeals Specialist for an opportunity in Remote!




Position Title: Appeals Specialist



Location: Remote CST



Anticipated Start Date: 10/14/2024
Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.


Expected Duration: 6+ Months of contract with possible extension



Job Type: [FULL TIME (>=30 HRS WEEKLY)], [CONTRACT], [Remote]



Pay Range: $20 - $24/hr

Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).


Shift Timing: 9 am - 6 pm CST











**Job Title:** Appeals Specialist II


**Position Purpose:**
The Appeals and Disputes Coordinator supports the documentation and processing of appeals, disputes, and reconsiderations to ensure compliance with state and National Committee for Quality Assurance (NCQA) requirements. This role aids the team in reviewing and processing these cases in a timely manner.

**Education/Experience:**

- High School diploma or GED required
- 1 - 2 years of related experience preferred
- Knowledge of appeals, disputes, and reconsiderations process preferred

**Key Responsibilities:**



- **Data Entry and Tracking:**

Perform data entry tasks to support the tracking, logging, and processing of appeals, disputes, and reconsiderations in alignment with regulatory and accreditation guidelines.

- **Documentation Preparation:**

Prepare and manage correspondence related to appeals, disputes, and reconsiderations. Maintain accurate and organized documentation files.

- **Review and Investigation:**

Review and investigate requests for appeals, disputes, and reconsiderations to determine the necessary follow-up actions.

- **Research and Evaluation:**

Conduct necessary research to evaluate and respond to appeals, disputes, and reconsiderations, ensuring decisions are made in a timely manner.

- **Case File Preparation:**

Prepare comprehensive case files, including all supporting documentation and determinations needed for review, processing, and reporting.

- **Data Gathering and Reporting:**
Collect and analyze data on appeals, disputes, and reconsiderations. Track and report on trends and outcomes to the team. Conduct outreach to update statuses, determinations, and explanations.

- **Compliance:**

Ensure all activities comply with relevant policies and standards.


Benefits:



BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

About BCforward:



Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.


BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.


BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.


To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.


This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.


Interested candidates please send resume in Word format Please reference job code 229259 when responding to this ad.


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Job Snapshot




Employee Type

Contractor



Location

Dallas, TX (Onsite)



Job Type

Health Care



Experience

Not Specified



Date Posted

09/17/2024