Cognizant is a large IT consulting firm that leverages modern technologies to transform a variety of business operations. The Provider Appeals Specialist is responsible for reviewing, researching, processing, and resolving provider appeals related to claims payment, reimbursement disputes, authorization denials, and contractual issues. This role serves as a liaison between healthcare providers, payer organizations, and internal departments to ensure appeals are handled accurately, timely, and in compliance with regulatory requirements, company policies, state laws, and contractual agreements. This is a remote role for candidates that live in the United States.
Role Responsibilities
- Review and investigate provider appeals related to denied, adjusted, or underpaid claims.
- Analyze claim histories, medical records, authorization documentation, contracts, and payment information to determine appeal outcomes.
- Interpret provider agreements, reimbursement methodologies, benefit plans, and healthcare regulations.
- Research root causes of claim disputes and identify appropriate corrective actions.
- Ensured HIPAA compliance when preparing and distributing appeal status notifications, determinations, and resolution correspondence.
- Ensure appeals are processed within established service-level agreements (SLAs) and regulatory timelines.
- Collaborate with cross-functional teams to research, evaluate, and resolve complex appeal cases.
- Maintain accurate documentation of all appeal activities in applicable systems and databases.
- Escalate high-risk or complex appeals to leadership when appropriate.
- Monitor trends in appeals activity and recommend process improvements to reduce recurring issues.
- Support quality audits, regulatory reviews, and compliance initiatives.
- Participate in training, client, and internal meetings.
Required Qualifications
- A High School diploma or equivalent is required; Associate's or Bachelor's degree preferred.
- 2+ years of experience in healthcare claims, provider services, appeals, billing, or related healthcare operations.
- Knowledge of medical terminology, healthcare claims processing, reimbursement methodologies, and payer guidelines.
- Understanding of CMS regulations, commercial insurance guidelines, and healthcare compliance standards.
- Experience working with healthcare claims management systems and Microsoft Office applications.
- Strong analytical, problem-solving, and investigative skills.
- Excellent written and verbal communication skills.
- Ability to manage multiple priorities and meet strict deadlines.
Preferred Qualifications
- Experience in managed care, health insurance, Medicare, Medicaid, or provider relations.
- Familiarity with ICD-10, CPT, HCPCS, and revenue coding.
- Knowledge of provider contracts and reimbursement structures.
- Healthcare-related certification or continuing education.
Key Competencies
- Attention to Detail
- Critical Thinking
- Customer Service
- Regulatory Compliance
- Analytical Research
- Time Management
- Conflict Resolution
- Decision-Making
- Collaboration and Teamwork
- Written Communication
Working Conditions
- Remote work
- Frequent interaction daily working directly with the client.
- Work may involve handling confidential patient and provider information in accordance with HIPAA regulations.
- Ability to meet productivity, quality, and turnaround time requirements.
Salary and Other Compensation:
Applications will be accepted until August 21st, 2026.
The hourly rate for this position is $18 - $19 per hour.
This position is also eligible for Cognizant’s discretionary annual incentive program, based on performance and subject to the terms of Cognizant’s applicable plans.
Benefits: Cognizant offers the following benefits for this position, subject to applicable eligibility requirements:
- Medical/Dental/Vision/Life Insurance
- Paid holidays plus Paid Time Off
- 401(k) plan and contributions
- Long-term/Short-term Disability
- Paid Parental Leave
- Employee Stock Purchase Plan
Disclaimer: The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.
Cognizant will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future.
Über Cognizant
Cognizant (NASDAQ: CTSH) i ist ein Technologiedienstleister und Entwickler von KI-Lösungen. Wir schlagen die Brücke zwischen KI-Investitionen und echtem unternehmerischem Mehrwert, indem wir ganzheitliche Full-Stack-KI-Lösungen für unsere Kunden entwickeln. Mit unserer fundierten Branchen-, Prozess- und Engineering-Expertise integrieren wir die spezifischen Anforderungen von Unternehmen passgenau in Technologiesysteme. So entfalten wir das menschliche Potenzial, erzielen greifbare Ergebnisse und sichern globalen Unternehmen in einer sich rasant wandelnden Welt den entscheidenden Vorsprung. Erfahren Sie mehr unter cognizant.ai oder @cognizant.
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