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BusinessOperations - Appeals Specialist II - J00909
Mindlance
- 🇺🇸 United States
- Remote
- Manager or above
- 1 day ago
1 day ago
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.
Education/Experience:
Requires a High School diploma or GED.
Requires 1 – 2 years of related experience.
Knowledge of appeals, disputes and reconsiderations process 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 appeals, disputes and reconsiderations data to track and report on trends and final outcomes to team including conducting outreach for an update on statuses, determinations, and explanations
Performs other duties as assigned
Complies with all policies and standards
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
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| Hiring Manager | Paulette Wynne | Number of Openings | 1 | |||
| Training Manager/Assignment Manager | Paulette Wynne | Newor Replacement New: A new contingent/temp worker is needed Replacement: A replacement request is only used to a backfill former contractors who did not start / did not use all their allocated budget) |
New | |||
| Target Start Date | 16 November 2026 | Hourly Max Bill Rate | $ 32.20 | |||
| Is this a hard start date, where a trainer is already assigned? | NO | Hourly Pay Rate (Bus Ops) | $ 23.00 | |||
| Assignment Duration (in months) | 6 months | FTE Salary Conversion Band | $ | |||
| Possibility to extend? | Maybe- depends on budget | Work Location if not Remote: If Remote: Remote to a specific state, nationally sourced, or specific time zone? |
Remote- Nationally- PST is ok but has to be able to work CST shift hours. | |||
Daily schedule (OT requirements) |
M-F CST M-F 7:00am-3:30pm (CST) / 8:00am-4:30pm (EST) - 30 min lunch M-F 7:00am-4:00pm (CST) / 8:00am-5:00pm (EST) - 1 hour lunch No overtime will be available |
Is this a field worker that is member facing or working within a partnered clinical facility? | NO |
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| Business Unit(s)/Health Plan(s) | Medicaid | Will this worker be working in a Centene facility or worksite? | NO |
BusinessOperations - Appeals Specialist II - J00909 · Mindlance