Appeals Examiner - On-Site - West Sacramento

$37,500 - $53,500/Yr

Gainwell Technologies - West Sacramento, CA

Full-time - Mid Level

West Sacramento, CA

Professional, Scientific, and Technical Services

About the position

As an Appeals Examiner at Gainwell Technologies, you will play a crucial role in reviewing provider appeals and ensuring accurate determinations based on established guidelines. This position focuses on analyzing and researching appeal documentation to address all aspects of the appeal while maintaining production goals and quality standards. You will also be responsible for resubmitting and adjusting claims based on approved appeals, all while adhering to confidentiality and compliance with HIPAA regulations.

Responsibilities

• Review provider appeals using approved guidelines and documents appeal determinations clearly and concisely.
• Analyze, research, and review appeal documentation to ensure all aspects of the appeal have been addressed properly and accurately.
• Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation.
• Maintain performance within defined quality and quantitative objectives.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

Requirements

• One (1) or more years of claims or appeals experience required.
• Experience working with insurance and/or medical terminology required.
• Highly proficient with exceptional level of accuracy required.
• Ability to research and verify claim payment issues.
• Knowledge of Microsoft products (Outlook, Word, Excel, and TEAMS).

Benefits

• Health insurance
• Tuition reimbursement
• 401(k) matching