Note: The job is a remote job and is open to candidates in USA. Cognizant is seeking a dedicated Provider Appeals & Grievance Specialist to join their team. The ideal candidate will be responsible for researching and resolving Medicaid provider appeals, which involves understanding member benefits, eligibility, provider contracts, and state Medicaid policies.
Responsibilities
- Research and resolve Medicaid provider appeals
- Investigate member benefits and eligibility
- Review provider contracts, billing and coding
- Understand Utilization Management and state Medicaid policies
Skills
- 1-2 years of Appeals and Grievance
- 1 Year of medical claims processing experience (Must be with a healthcare plan, not on behalf of provider or provider's office)
- 2 Years of medical health insurance (Must be with a managed healthcare plan, not on behalf of provider or provider's office)
- Medicaid/Medicare Insurance Customer Service with managed care plans or directly with CMS
- Billing and Coding-Medical Insurance
- Knowledge of Member/Provider Appeals and Grievances, processes, resolutions, compliance TAT
- Self-resolved troubleshooting ability for various IT issues
- Knowledge of QNXT
- Knowledge of PEGA
- Knowledge of SharePoint
- Sense of urgency with production and responsiveness to email and MS Teams
- Ability to create and fax written communication in a professional manner including spelling and grammar
Benefits
- Medical/Dental/Vision/Life Insurance
- Paid holidays plus Paid Time Off
- 401(k) plan and contributions
- Long-term/Short-term Disability
- Paid Parental Leave
- Employee Stock Purchase Plan
Company Overview
- Cognizant is a professional services company that helps clients alter their business, operating, and technology models for the digital era. It was founded in 1994, and is headquartered in Teaneck, New Jersey, USA, with a workforce of 10001+ employees. Its website is https://www.cognizant.com.