Fair Hearing Specialist

Job Description

Acentra seeks a Fair Hearing Specialist to join our growing team.

Job Summary:

The Fair Hearing Specialist plays a crucial role in providing support and assistance to individuals who are going through the recipient Fair Hearing judicial process established by the Agency for Health Care Administration (AHCA). Their role is to:

• Guide and advise individuals who have received a denial of their prior authorization services request and wish to file a reconsideration appeal.
• Provide information on the legal process, help individuals gather and organize relevant documentation, and support them in drafting and submitting their appeals.
• Act as a liaison between individuals and the AHCA, ensuring that all communication is clear and accurate.

Job Responsibilities:

• Conduct daily interactions with both external and internal customers.
• Ensure that all review requests and reports are processed promptly and accurately.
• Scan incoming faxed documents into the appropriate medical records and establish records in the review system.
• Prioritize and address requests and assignments professionally.
• Build cooperative relationships and ensure that customer confidentiality is always maintained.
• Review Fair Hearings notifications/requests submitted by the Agency or Department of Children and Families (DCF) Area Office.
• Acknowledge receipt of the notification/request on the same business day as received.
• Determine whether an administrative extension is required for outpatient services and perform the necessary data entry to extend services if applicable.
• Compile the case file, print copies of the required information, and prepare information for internal approval.
• Submit the evidence packet in compliance with contract timeliness and ensure the submission and delivery of the requested case file within three (3) business days of receiving the notification of a request for a Fair Hearing.
• Identify opportunities to improve service, work processes, and financial performance.
• Recommend methods to achieve improvements, including expense management.
• Assist in the implementation of quality improvement initiatives.
• Perform any other duties as assigned.

_ **** The selected candidate must reside in the Tampa, Florida area, as this is an onsite role. ****_

Qualifications

Required Qualifications/Experience:

• High School Diploma OR GED equivalent.
• 1+ years of experience with Microsoft Word, Outlook, and SharePoint.
• Knowledge of Medical Terminology.
• Strong written and verbal communication skills.
• Expertise in the field of image processing and form recognition.
• Experience in scanning and bookmarking.
• Familiar with customer interaction techniques.
• Knowledge and experience in ICD-10 coding.
• Good communication skills.
• Aptitude to work effectively in a team environment.
• Ability to follow detailed instructions with precision.
• Comfortable working under close supervision.
• Maintain a high level of confidentiality.

Preferred Qualifications/Experience:

• Associate's degree or higher-level degree.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is $16.00-17.00 / hour.

_ “Based on our compensation philosophy, an applicant’s placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”_

_ Please apply directly on our careers site using the following link: https://apply.workable.com/acentra-health/j/DD66579DCA/_

Additional Information

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives nationwide. Our company cares about our employees, giving you the tools and encouragement you need to achieve the finest work of your career.

Thank You!

We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may interest you. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

EOE AA M/F/Vet/Disability

Acentra Health 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, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.