Appeals Coordinator

• Experience in claims processing, medical/ pharmacy precertification, appeals and grievances coordination or other applicable related work experience.
• Perform analysis and research of requests received for medical grievances, appeals for final resolution or referral to the Clinical Medical Appeals and Grievance (MAG) Staff.
• Maintains advanced end user knowledge of multiple systems including vendor medical management and claims systems.
• Review medical records to determine if records satisfy the requested or supporting information required.
• Maintain current medical terminology knowledge.
• Perform data corrections and initiate adjustments related to appeals originating from the Medical Grievance and Appeals Department.
• Communicate decisions through appropriate system updates.
• Demonstrates commitment to excellent customer experience.
• Attest to training competency related to medical terminology and new/revised processes.
• Ensure HIPAA compliance/PHI privacy.
• Assists with research and preparation of appeals files for accreditation site visits.
   

raksha.saxena@artech.com