Description
General Summary of Position
Monday - Friday, 8:30am - 5pm schedule. Position requires 1 day per week on-site (office located in Rosedale, Maryland)
Manages Maryland and District of Columbia member and provider medical appeals, Maryland complaints and grievances. Responsible for member advocate functions. Interacts directly with members, staff, physicians, and others on the telephone to resolve issues. Acts as a resource and documents all information as it relates to medical appeals/complaints and grievances. Assists with the collection of quality improvement information via telephone. Responsible for computer data input, tracking, trending, clerical, survey processing, outbound calls, and correspondence. We recruit, retain, and advance associates with diverse backgrounds, skills, and talents equitably at all levels.
Primary Duties and Responsibilities
Minimum Qualifications
Education
- Associate's degree required; Bachelor's degree preferred or
- An equivalent combination of education and related experience
Experience
- 1-2 years Customer service experience in a managed care or social service setting required
- Medical appeals processing, medical billing claims auditing, and coordination of benefits experience preferred
Knowledge, Skills, and Abilities
- Ability to type 40 words per minute.
- Filing skills.
- Knowledge of claims processing and medical billing.
- Knowledge of managed care/healthcare industry preferred.
- Ability to process complex business rules simultaneously to render decisions.
- Attention to detail.
- Logical reasoning and deduction skills for error and problem resolution.
- Working knowledge of various computer software applications, including Microsoft Word and Excel and medical software.
- Excellent verbal and written communication skills.
Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:- Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
- Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
- Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
- More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.
Apply on company website
Find Connections via Linkedin
