Fair Hearing Specialist (Remote)
- Are you an experienced Fair Hearing Specialist looking for a new challenge?
- Do you value care management and quality improvement?
- Are you motivated, energetic, and excited to become part of the Kepro team?
If so, you might be our next new team member!
Who we need:
The Fair Hearing Specialist will support and assist the recipient fair hearing judicial process established by the Agency for Health Care Administration (AHCA). For prior authorizations services request denial and reconsideration appeals.
Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.
People Focused. Mission Driven.
Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.
We do this through our people.
At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.
Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.
What you’ll do:
- Daily interaction with external and internal customers in order to ensure timely and accurate processing of review requests and reports.
- Scan incoming faxed documents into appropriate medical records.
- Establish records in review system.
- Provides courteous and prompt service to all internal and external customers. Prioritizes and addresses requests and assignments in a professional manner to develop cooperative relationships and to ensure that customer confidentiality is assured.
- Review fair hearings notification/request submitted by the Agency or DCF Area Office.
- Provide email acknowledgement of receipt of the notification/request on the same business day as received.
- Determine whether an administrative extension is required for non-inpatient services, and perform required data entry to extend services if applicable.
- Compile case file, print copies of the required information, and prepare information for internal approval.
- Ensure submission and delivery of requested case file within three (3) business days of the receipt of the notification of a request for a fair hearing.
- Identifies opportunities and recommends methods to improve service, work processes and financial performance, e.g. expense management. Assists in the implementation of quality improvement initiatives.
- Performs other services as required.
What you’ll need:
- High School Diploma or GED required; Associates or higher degree preferred.
Knowledge, Skills, Abilities
- Image processing and form recognition; scanning and bookmarking; customer interaction, ICD-9 coding knowledge and experience preferred. Must have good communication skills. Requires ability to follow detailed instructions. Able to work under close supervision.
- Ability to work with confidential information.
- One year experience with Microsoft products; knowledge of Medical Terminology; Word processing proficiency
We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!
~ The Kepro Talent Acquisition Team
Mental and Physical Requirements
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.
EOE AA M/F/Vet/Disability
Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.