Administrative Skills, Analysis Skills, Billing, Call Center Operations, Cancer, Claims Management, Claims Processing, Clinical Information, Clinical Validation, Communication Skills, Customer Relations, Customer Support/Service, Data Analysis, Detail Oriented, Documentation, File Maintenance, Health Insurance, Healthcare, Healthcare Providers, Insurance, Legal, Multitasking, Organizational Skills, Skin Care, Time Management, Training/Teaching, Writing Skills
Appeals Coordinator
Our client, a leading company specializing in non-invasive skin cancer treatment, is seeking an experienced and detail-oriented Appeals Coordinator to join their team. This is a hybrid position, allowing you to work from home two days per week and spend the other three days in our Burr Ridge office. As an Appeals Coordinator, you will play a crucial role in investigating and resolving complex patient and insurance provider complaints related to enrollment and claims, medical appeals, and provider payment disputes within the healthcare industry.
Responsibilities:
- Appeals Investigation: Investigate and resolve patient and insurance provider complaints, conducting in-depth reviews of clinical information and nationally recognized criteria to determine the need for requested services.
- Case Review: Prepare detailed reviews of cases that do not meet the criteria for requested services, ensuring accurate and comprehensive documentation.
- Data Analysis and Reporting: Gather, analyze, and report all information related to appeals, providing clear and concise insights to relevant stakeholders.
- Communication and Outreach: Write accurate letters and other client-facing communications, conduct outreach to determine appeal statuses, determinations, and explanations, and communicate effectively with members, providers, and customers.
- Appeals Meeting: Schedule and run appeals meetings, facilitating discussions among relevant parties to reach resolutions.
- Provider Education: Educate providers, members, attorneys, and other stakeholders involved in the appeals process on relevant procedures and requirements.
- Administrative Tasks: Oversee administrative tasks, including settling billing issues and maintaining organized appeal files.
Qualifications:
- 1-3 years of claims processing experience in the health insurance industry, with a focus on customer service and call center operations.
- Experience in aged claims management and grievance and appeals processing is highly desirable.
- Excellent organizational skills and attention to detail to handle multiple cases simultaneously.
- Strong communication and customer service skills to interact effectively with various stakeholders.
- Critical thinking skills to assess each unique case and apply appropriate appeal procedures.
- Knowledge of legal and federally mandated rules regarding claims processing and appeals.
- Ability to work independently, handle interruptions, and multitask effectively.
- Proficient in filing and maintaining organized logs for all appeals.
Job Details:
- Position: Appeals Coordinator (Hybrid)
- Location: Work from home two days per week, and three days in Burr Ridge office.
- Salary: Competitive, up to $22.00 per hour.
- Benefits: Medical, Dental, and Life Insurance provided.
- Fun and positive work environment with opportunities for growth and development.
If you have the relevant experience and a keen eye for detail, we invite you to apply for the position of Appeals Coordinator with our dynamic and growing healthcare device company. Join our team in making a difference in the lives of patients and healthcare providers across the country.