The Appeals Processing Senior Representative position at Evernorth, a division of Express Scripts, focuses on conducting administrative claims and appeals coverage determinations remotely. The ideal candidate will have experience in medical coding and an understanding of related regulations, with a commitment to maintaining compliance and accuracy
Job Summary
The role involves making coverage determinations on retrospective administrative outpatient claims and appeals such as bundling reviews.
Employees must adhere to strict HIPAA regulatory requirements and limit access to protected health information to the minimum necessary amount.
The position offers a comprehensive benefits package including medical, vision, dental, 401(k), and paid time off starting on day one.
Matching Summary
Match Score: 85
The Appeals Processing Senior Representative position at Evernorth, a division of Express Scripts, focuses on conducting administrative claims and appeals coverage determinations remotely. The ideal candidate will have experience in medical coding and an understanding of related regulations, with a commitment to maintaining compliance and accuracy.
Salary
Base: $19 - $29 USD per hour; Bonus/Equity: Eligible for annual bonus plan; Benefits: Medical, vision, dental, 401(k), life insurance, tuition reimbursement, 18 days PTO
Skills & Requirements
Must-have
AAPC CPC or AHIMA CCS-P certification required
Retrospective outpatient claims review experience
HIPAA regulatory compliance knowledge
Nice-to-have
Strong research and analytic skills
Ability to work independently with good judgment
Familiarity with state and federal regulations
Key Requirements
High school education or GED required
Valid AAPC CPC or AHIMA CCS-P certification (Apprentice stage not eligible)
1+ year experience in CPT-4 and ICD-9/ICD-10 coding preferred