G&A Specialist II (Mississippi Hybrid)

Job description

TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the state and supported by CareSource’s national leadership in quality and operational excellence. TrueCare offers locally based provider services through provider engagement representatives and customer care. Our sole mission is to improve the health of Mississippians by leveraging local physician experience to inform decision-making, aligning incentives, using data more effectively, and reducing friction between the delivery and financing of health care. By doing so, TrueCare will change the way health care is delivered in Mississippi. Job Summary: The Grievance & Appeals Specialist II reviews appeals submitted by Medicaid and Medicare providers and all future providers contracted with CareSource. This is a hybrid position, working in the Ridgeland Office on Tues/Wed/Thurs. Remote on Mon/Fri. . Essential Functions: - Prepare the appeals for clinical review and be responsible for recording and tracking on a regular basis - Review submitted appeals daily for validation of the appeal - Identify appropriate claim problem within the appeal -...