APPEALS SPECIALIST III
Posted 2025-05-01About 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
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