Appeals Specialist (161112)

Job Description

Job Description

A-Line Staffing is now hiring a Fully Remote Appeals Specialist in MO!

We are seeking an experienced Appeals Specialists to join our UM Shared Services team. This role will support multiple Medicaid health plans, handling provider disputes, reconsideration requests, and claims/authorization reviews. You will gain exposure to various health plans, enhance your knowledge of claims and authorizations, and develop key skills in utilization management.

This is a fully remote position with a collaborative and supportive team culture.

Appeals Specialist Compensation

• The pay for this position is $23.00/hr
• Benefits are available to full-time employees after 90 days of employment
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates

Appeals Specialist Highlights

• This position is a contract assignment with potential for permanent hire based on attendance, performance, and business needs
• The required availability for this position

Work Schedule:

o M-F 7:00am – 3:30pm CST / 8:00am – 4:30pm EST (30 min lunch)

o M-F 7:00am – 4:00pm CST / 8:00am – 5:00pm EST (1-hour lunch)

o No overtime available

Appeals Specialist Responsibilities

· Transfer and evaluate cases from CenPAS

· Review provider disputes and reconsideration requests

· Modify authorizations as needed

· Respond to claims and utilization management inquiries

· Participate in daily team meetings, leadership huddles, and 1:1 sessions

· Complete tasks independently while following established processes

Appeals Specialist Requirements

Required:

• High school diploma or equivalent
• Knowledge of reviewing claims and authorizations
• Familiarity with TruCare and Amisys systems
• Data entry/typing skills (minimum 40 wpm)
• Knowledge of claims/coding
• Knowledge of authorizations

Preferred:

• Experience with provider disputes/reconsiderations

If you think this Appeals Specialist position is a good fit for you, please reach out to me—feel free to e-mail me at Hforet@alinestaffing.com , or apply to this posting!