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Operations Appeals Assistant

    • Job Tracking ID: 512689-611386
    • Job Location: Milwaukee, WI
    • Job Level: Mid Career (2+ years)
    • Level of Education: 2 year degree
    • Job Type: Full-Time/Regular
    • Date Updated: March 07, 2018
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
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Job Description:

The Operations Appeal and Encounter Assistant is responsible for supporting and assisting the Operations Appeal and Encounter Specialist in the timely and accurate review and response of all Medicare and Medicaid reviews. This role is responsible for resolution and handling of provider appeals according to CMS and/or DHS guidelines.

  1. Ensure the accurate entry of Medicare and Medicaid appeals into the Provider Appeal Database.
  2. Accurate and timely mailing of appeal letters to providers; including but not limited to acknowledgement letters, follow up letters, dismissal letters. etc.
  3. Supports timely and accurate reporting of appeal database to Operations Management and various iCare committees.
  4. Review and handling of Medicaid appeals as it relates to untimely denial decisions.
  5. Supports analyzing and tracking of appeal trends and issues.
  6. Supports the updating of policy and procedures as it relates to provider appeals.
  7. Supports efforts to proactively prevent or reduce appeals.

Experience and Skills:

  1. Associate degree and equivalent experience in medical, medical records or insurance environment.
  2. 1-3 years claims experience in HMO or insurance environment.
  3. Ability to analyze all facets of complex claim situations and resolve them using empathy, tact and judgement.
  4. Proven analytical skills and detail oriented ability.
  5. Experience with multiple product lines preferred (HMO, Medicaid, and Medicare).
  6. Working knowledge of managed care contractual provisions.
  7. Working knowledge of medical terminology, CPT-4 procedure, ICD-9 diagnosis codes, and DRG experience.
  8. Hands-on PC or CRT experience to include knowledge of data entry, word processing and spreadsheet applications. Demonstrated use of Microsoft Office applications such as Access, Excel, Word, and Outlook.
  9. Excellent interpersonal and communication skills
  10. Excellent coordination and organizational skills


  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
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