Medical Appeals Representative

Location: Baton Rouge, LA (Main Campus)
Work Arrangement: 100% Onsite
Pay Rate: $25/hr

Position Summary

The Medical Appeals Representative provides operational support for the intake, review, prioritization, and coordination of medical appeals to ensure timely and compliant processing. This role performs initial assessment of incoming appeals, distinguishes between expedited and standard requests, and facilitates accurate routing to clinical staff. The ideal candidate is highly organized, detail-oriented, and capable of working independently in a fast-paced healthcare environment while maintaining compliance with HIPAA and regulatory requirements.

Key Responsibilities

• Review incoming appeal requests received via mail, fax, and electronic submission channels.

• Determine appeal eligibility and accurately classify cases as expedited or standard based on regulatory requirements.

• Establish and maintain appeal cases within designated systems, including EPIC.

• Prioritize, organize, distribute, and track appeals to appropriate clinical staff.

• Monitor appeal workflows to ensure compliance with service level agreements and regulatory deadlines.

• Conduct research and prepare supporting documentation for appeal processing.

• Assist Medical Appeals Specialists with case setup, routing, and processing during periods of high volume or staff absence.

• Maintain accurate case records and documentation in accordance with audit and retention requirements.

• Ensure compliance with HIPAA, PPACA, Department of Insurance (DOI), URAC, and other applicable regulations.

• Collaborate with internal departments to facilitate resolution and support operational compliance.

• Identify workflow improvement opportunities and communicate recommendations to leadership.

• Perform additional duties as assigned.

Qualifications

Education

• High School Diploma or GED required.

Experience

• Minimum 3 years of insurance experience, including benefits and claims research.

• Minimum 2 years of customer service and/or claims processing experience.

• Experience may be concurrent.

• Experience with Facets is preferred.

Required Knowledge, Skills & 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 healthcare regulations, accreditation standards, and appeals processes.

• Strong organizational, prioritization, and time management skills.

• Exceptional attention to detail and accuracy.

• Ability to work independently and manage competing priorities.

• Strong written and verbal communication skills.

• Proficiency with Microsoft Office applications, including Word and Excel.

Preferred Systems Experience

• EPIC

• Facets

• ESI

• Provider Portal

• Common Query

• Adobe Standard

Work Environment

• 100% onsite at Baton Rouge, LA

• Standard office environment.

• High-volume, deadline-driven workload requiring strong prioritization and independent decision-making.

• Flexibility to support team coverage and changing business needs.

Technical Product Owner – AI & Machine Learning (Contract)

Location;: Baton Rouge, LA  (Hybrid- 3 days per week)
Duration: 6 Months
Pay Rate: $65/hr

Job Overview:

We are seeking a Technical Product Owner to support the delivery of Artificial Intelligence (AI) and Machine Learning (ML) initiatives. This role will work closely with Data Science, Engineering, and Business teams to translate requirements into actionable work, manage product backlogs, and facilitate Agile delivery processes.

The ideal candidate has experience working in Agile environments, managing Azure DevOps backlogs, and supporting the successful delivery of data-driven or AI-enabled solutions.

Key Responsibilities

• Support the delivery of AI and Machine Learning initiatives within established project timelines and objectives.
• Partner with the Data Science Manager to evaluate, organize, and prepare incoming business requests for technical refinement.
• Translate business and technical requirements into user stories, acceptance criteria, and prioritized backlog items.
• Facilitate Agile ceremonies including sprint planning, backlog refinement, sprint reviews, and related delivery activities.
• Maintain Azure DevOps (ADO) Boards, ensuring backlog health, sprint tracking, velocity reporting, and delivery metrics remain current.
• Collaborate with Engineering, Data Science, Project Management, and Portfolio teams to coordinate priorities, timelines, and dependencies.
• Clarify requirements and remove delivery roadblocks by working closely with technical teams and stakeholders.
• Monitor project progress, risks, and dependencies, escalating issues as needed.
• Maintain project documentation, status reporting, and delivery artifacts.
• Recommend improvements to Agile processes, backlog management, and delivery workflows.

Required Qualifications

• Experience as a Product Owner, Technical Product Owner, Product Analyst, Business Analyst, or similar delivery-focused role.
• Experience supporting Agile, Scrum, SAFe, or other iterative delivery methodologies.
• Hands-on experience with Azure DevOps (ADO), including backlog management and sprint planning.
• Experience supporting Program Increment (PI) Planning, release planning, or multi-sprint delivery initiatives.
• Experience creating user stories, acceptance criteria, and managing product backlogs.
• Understanding of Artificial Intelligence, Machine Learning concepts, and model lifecycle management.
• Knowledge of cloud platforms, data engineering concepts, and modern data ecosystems.
• Strong communication, stakeholder management, and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.

Preferred Qualifications

• Experience supporting Data Science, Analytics, or Machine Learning teams.
• Familiarity with MLOps concepts and AI product delivery frameworks.
• Experience working within enterprise-scale Agile environments.
• Knowledge of Azure cloud technologies and data platforms.

Success Metrics

• High-quality backlog management and user story development.
• Consistent sprint execution and delivery predictability.
• Accurate project tracking, reporting, and dependency management.
• Effective collaboration across business and technical teams.
• Timely delivery of project objectives and milestones.

Job Title: Provider Dispute Intake Coordinator

Duration- 6 Months

Onsite position – with an opportunity for Hybrid (3days onsite – 2 days remote) after training period

Pay- $17-$18/hr

 

Position Summary

The Provider Dispute Intake Coordinator plays a key role in supporting the Provider Disputes team by managing the intake, tracking, and distribution of provider disputes, appeals, and related correspondence. This position ensures that all incoming cases are accurately recorded, prioritized, and assigned for timely review and resolution.

This role also provides administrative and clerical support to the department, helping maintain compliance with regulatory requirements and internal policies while supporting efficient claims processing and communication across teams.

Key Responsibilities

• Review processed claims to identify valid provider disputes
• Create and assign dispute cases within EPIC to Provider Dispute Specialists
• Coordinate intake, tracking, prioritization, and distribution of incoming disputes, appeals, and correspondence
• Maintain accurate records of case flow and ensure timely routing to appropriate teams or individuals
• Assist leadership with administrative tasks, reporting, and file maintenance
• Prepare materials for appeal reviews, including case documentation, binders, and communications
• Ensure all documentation complies with privacy regulations and internal policies
• Forward medical appeals, FEP appeals, and correspondence to appropriate departments in a timely manner
• Support internal coordination by following up with staff and departments to ensure timely claims processing and resolution
• Maintain electronic and physical filing systems and update dispute tracking databases
• Generate reports for internal meetings and ad hoc requests
• Monitor and maintain office supply inventory and related documentation
• Navigate systems such as Facets and Jiva to review claims and authorizations
• Perform other administrative and departmental duties as assigned

Qualifications

Education

• High School Diploma or equivalent required

Experience

• Minimum of 2 years of experience in a medical or insurance office setting
• Experience with claims processing or provider/member services required
• Familiarity with healthcare systems such as Facets and EPIC preferred

Skills & Competencies

• Strong organizational and time management skills
• Ability to prioritize and manage multiple tasks in a fast-paced environment
• Attention to detail and accuracy in data entry and documentation
• Proficiency in Microsoft Office (Word, Excel, PowerPoint)
• Strong communication and coordination skills
• Ability to handle sensitive information in compliance with privacy regulations

Work Environment

• Office-based role in a professional, low-noise environment
• Work is primarily performed while sitting or standing at a desk
• Requires the ability to analyze, document, and manage detailed information

Reporting Structure

• Reports to: Supervisor, Provider Disputes
• This position does not have direct reports

Why Join Us

You’ll be part of a collaborative team that plays a critical role in ensuring accurate claims handling and provider satisfaction. This position offers an opportunity to build expertise in healthcare operations, claims processing, and dispute management within a supportive environment.