APPEALS SPECIALIST III

About us: Lumen Solutions Group Inc., a dynamic small and minority-owned, Disadvantaged Business Enterprise headquartered in Florida, USA. As a leading consulting services and solutions provider, we focus on IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation for our clients. Our client base includes Fortune 500, Government... non-profit and emerging growth companies. JOB TITLE: APPEALS SPECIALIST III 3 - 5 years of experience Seasoned regulations and rules of CMS Medicare and Medicaid - Maryland Medicare and Medicaid MANDATORY Basic knowledge for policies and regulations - whatever rule they are looking for Experience with insurance health plan side along with payer side Appeals and grievances related tasks Appeals - investigate the appeal - claim that is denied, authorization that is denied Communicate with other business areas Grievances - reading through the content and see what is the issue and then have the critical thinking to solve the problem. Pull in resources who can resolve the project • **Lumen and / or its clients will not provide equipment (Laptop, monitor, etc.) to the selected contractor. The contractor must have their own equipment. Access to a virtual desktop set up (software) will be provided by Lumen’s client, allowing the user access to the required systems and technology. *** Lumen Solutions Group Inc. is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans Apply Job!