Appeals and Provider Dispute Specialist

We are seeking a highly analytical Appeals & Provider Dispute Specialist to manage complex reconsideration requests within our client's Medicaid Line of Business. This role is dedicated to the comprehensive research, investigation, and resolution of provider appeals to ensure clinical and financial accuracy. You will serve as a key decision-maker in the dispute lifecycle, utilizing CenPAS and AMISYS to determine if initial claim denials should be upheld or overturned. salary: $22 - $23 per hour shift: First work hours: 7 AM - 4 PM education: High School Responsibilities • Conduct comprehensive research into provider disputes, grievances, and reconsideration requests transferred from CenPAS. • Evaluate claims and medical records against medical necessity guidelines, CPT/ICD-10 coding standards, and Medicaid benefit coverage. • Resolve disputed claims within the AMISYS system, accurately calculating reimbursements or finalizing denials based on independent analysis. • Modify existing authorizations in the system to align with the final resolution of the appeal or dispute. • Ensure all responses and resolutions meet strict state, federal, and internal regulatory timelines. Skills • Appeals • Amisys • Medical Coding • Medicaid • Claims Processing Qualifications • Years of experience: 3 years • Experience level: Experienced Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status. At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [email protected]. Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility). This posting is open for thirty (30) days. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Apply tot his job