Appeals Specialist II

Position Purpose: Supports the documentation and processing of appeals, disputes and reconsiderations to ensure they are in accordance with state and National Committee for Quality Assurance (NCQA) requirements. Support the team to ensure appeals, disputes and reconsiderations are reviewed and processed timely. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Experience with the documentation and processing of No Surprises Act (NSA) Open Negotiation Requests (ONRs), Independent Dispute Resolution (IDR), and/or state healthcare payment disputes, preferred. Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up Conducts research needed to evaluate, process, and respond to appeals, disputes and reconsiderations to ensure a timely decision Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes and reconsiderations Gathers ap