A&G Dismissal Specialist

A&G Dismissal Specialist

Requirements

• Proven work experience with appeals and grievances or healthcare environment.
• Work experience demonstrating verbal and written communication skills.
• Customer service experience including resolving escalated customer complaints or concerns.
• Experience handling complex situations and/or projects.
• Proficient in Microsoft Office Suite applications including Excel, Word, Power Point, and Outlook.
• Working experience using MS Excel to sort, filter, and track trends with claims errors to provide resolution.
• Ability to work flexible hours, weekends, and evenings due to business needs.
• High School Diploma or GED from an accredited institution.

Responsibilities

• Responsible for case development and resolution of non-clinical cases, such as: certain types of claim denials, member complaints, and non-par provider appeals.
• Research issues.
• Understand claim denials.
• Communicate with other departments to confirm submitter information.
• Reference and understand HF’s internal health plans’ policies and procedures to frame decisions.
• Interpret regulations.
• Resolve cases and make critical decisions.
• Edit and finalize resolution letters.
• Manage all duties within regulatory timeframes.
• Communicate effectively to hand-off or pick-up work from colleagues.
• Work within a framework that measures productivity and quality for each Specialist against expectations.
• Additional duties as assigned.

Preferred Qualifications

• Experience with OnBase
• Bachelor’s Degree from an accredited institution
• Working experience using MS Excel to sort, copy and paste, as well as experience creating and using pivot tables.
• Frequently communicates complex information and interacts with management. Can present, resolve conflicts, and address delicate situations.