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Medical Appeals Representative

Iconma

Baton Rouge, LA

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JOB DETAILS
SKILLS
Accounts Payable, Accreditation Standards, Claims Processing, Communication Skills, Compensation and Benefits, Current Procedural Terminology (CPT), Customer Support/Service, Detail Oriented, Documentation, Establish Priorities, Federal Laws and Regulations, HIPAA (Health Insurance Portability and Accountability Act), Health Insurance, Health Plan, Healthcare Common Procedure Coding System (HCPCS), ICD-10, Insurance, Leadership, Legal, Maintain Compliance, Marketing, Medical Assistance, Microsoft Excel, Microsoft Office, Microsoft Word, Network Administration/Management, Organizational Skills, Presentation/Verbal Skills, Process Development, Process Improvement, Record Keeping, Regulatory Compliance, Regulatory Requirements, State Laws and Regulations, Support Documentation, Time Management, Utilization Review Accreditation Commission (URAC), Writing Skills
LOCATION
Baton Rouge, LA
POSTED
3 days ago
Our Client, a Health Insurance company, is looking for a Medical Appeals Representative for their Baton Rouge, LA location.
 
Responsibilities:
  • Ensures the timely and accurate processing of all medical appeals by performing intake review, prioritization, and case coordination activities. Supports departmental workflow by organizing, distributing, and tracking appeals while ensuring compliance with PPACA, Department of Insurance (DOI), and URAC guidelines.
  • Accountabilities and Essential Functions
  • Reviews incoming appeal requests (mail, fax, electronic) to determine eligibility and classification
  • Differentiates between expedited and standard appeals to ensure compliance with regulatory timeframes
  • Establishes and maintains appeal cases within designated systems (e.g., EPIC)
  • Prioritizes, organizes, distributes, and tracks appeals to appropriate clinical staff
  • Coordinates workflow to ensure timely processing and adherence to service level expectations
  • Performs research and prepares documentation to support appeal processing
  • Assists Medical Appeals Specialists during periods of high volume or absence, including case setup, routing, and processing
  • Maintains accurate records and documentation in compliance with data retention and audit requirements
  • Ensures adherence to HIPAA, accreditation standards, and all applicable federal and state regulations
  • Collaborates with internal departments to support resolution and ensure compliance
  • Identifies process improvement opportunities and communicates recommendations to leadership
  • Performs additional duties as assigned within the scope of the role
  • Nature and Scope
  • Individual contributor role with no direct reports
  • Reports to: Supervisor, Medical Appeals
  • Operates in a high-volume, deadline-driven environment requiring independent work and prioritization
  • Key Internal/External Contacts
  • Appeals and Grievances
  • Member Services and Customer Service
  • Provider Services and Network Administration
  • Medical Management and Legal
  • Marketing and Accounts Payable
 
Requirements:
  • Education
  • High School Diploma or equivalent required
  • Work Experience
  • 3 years of insurance experience, including benefits and claims research (required)
  • 2 years of experience in customer service and/or claims processing (required)
  • Experience may run concurrently
  • Experience with Facets application (preferred)
  • Knowledge, Skills, and Abilities
  • Knowledge of health insurance benefits and claims processing procedures
  • Ability to interpret benefit plans across multiple lines of business
  • Familiarity with CPT, ICD-10, and HCPCS coding systems
  • Understanding of accreditation standards, regulatory requirements, and internal systems
  • Strong organizational, prioritization, and time management skills
  • High attention to detail and accuracy
  • Ability to work independently in a fast-paced and changing environment
  • Strong written and verbal communication skills
  • Proficiency in Microsoft Office applications (Word, Excel)
  • Preferred Technical Knowledge
  • EPIC, Facets, ESI
  • Provider Portal, Common Query
  • Adobe Standard
 
Why Should You Apply?

About the Company

I

Iconma

ICONMA is a global information consulting management firm providing Professional Staffing Services and Project-Based Solutions for organizations in a broad range of industries.

  • Corporate Headquarters in Troy, Michigan; 20+ locations worldwide.
  • Certified Woman-Owned Business Enterprise (WBE); certified by Women’s Business Enterprise National Council, National Women Business Owners Corporation (NWBOC); and California Public Utilities Commission (CPUC).
  • Founded in 2000
  • 2000+ Employees

The company was founded on the principle that success is derived from delivering high quality service and resources in the most responsive, flexible, and innovative way. ICONMA invests in people and resources with a single goal: To provide our customers with the highest quality service in the most responsive manner. Through its network of offices, ICONMA provides the resources to help clients maintain their competitive advantage.

COMPANY SIZE
2,000 to 2,499 employees
INDUSTRY
Management Consulting Services
EMPLOYEE BENEFITS
401K, Employee Referral Program, Life Insurance
FOUNDED
2000
WEBSITE
https://www.iconma.com/