Highlights
This team member will interact with Customer Service, Utilization Management, Medical Directors, and other internal teams as necessary to effectively triage incoming complaints and appeals. Collaborate with Customer Service, Utilization Management, Medical Directors, and other internal teams to effectively manage incoming concerns.
Numbers & Facts
| Location | Grand Rapids, MI (Remote) |
| Industry | Staffing/Employment Agencies |
| Salary | $18–$20 Per Hour |
| Company Size | 100 to 499 employees |
| Year Founded | 1990 |
| Website | http://www.sunrisesys.com/ |
Description
Job Title: Appeals Intake Coordinator
Job ID:26-03992
Location: Remote
Duration: 07 months on W2 contract
Job Summary:
The Appeals intake coordinator position is focused on the processing of incoming member and provider Medicare appeals and grievances. This team member will screen incoming complaints and appeals for level of urgency, benefit or medical necessity issues and other appropriate inquiries. This team member will assign the incoming concern to the appropriate analyst and may assist in investigations, documentation gathering, and correspondence as needed. This team member may also participate in auditing and monitoring activities as assigned. This team member will promote quality member care and customer service/satisfaction.
This team member will interact with Customer Service, Utilization Management, Medical Directors, and other internal teams as necessary to effectively triage incoming complaints and appeals.
Essential Functions:
Review and triage incoming Medicare appeals and grievances based on urgency and type of concern.
- Assign incoming complaints, appeals, and inquiries to the appropriate analyst for review and resolution.
- Assist with investigations, documentation collection, and correspondence related to appeals and grievances.
- Correspond with members, providers, and regulatory agencies regarding decisions and actions.
- Collaborate with Customer Service, Utilization Management, Medical Directors, and other internal teams to effectively manage incoming concerns.
- Participate in auditing and monitoring activities as assigned.
- Communicate, collaborate, and cooperate with internal and external stakeholders.
- Promote quality member care and customer service satisfaction.
- Adhere to all compliance requirements and HIPAA regulations.
- Support departmental goals that contribute to the overall success of the organization.
Qualifications:
Education:
- High School Diploma or equivalent required.
Experience:
- Minimum of one (1) year of health insurance or managed care experience performing Appeals and Grievances functions.
Knowledge, Skills, and Abilities:
- Knowledge of healthcare delivery systems.
- Ability to work in a fast-paced environment with changing priorities.
- Strong collaboration and teamwork skills.
- Effective written communication skills.
- Strong time management and prioritization skills.
- Demonstrated problem-solving abilities.
- Strong organizational skills and attention to detail.
- Ability to identify and define problems, gather and analyze information, establish facts, draw valid conclusions, and implement changes related to federal regulations.
Technical Skills:
- Proficiency with Microsoft Office applications.
- Experience with Health Edge, Epic, and/or Facets preferred.
Compensation:
The hourly rate for this position is between $18.00-20.00 per hour.
Factors which may affect starting pay within this range may include [geography/market, skills, education, experience and other qualifications of the successful candidate
Benefits:
Sunrise offers ACA compliant medical coverage/dental insurance/vision insurance to all employees. We also offer Sick time benefits as required per State regulations.
Contact:
Jaya Balaji: jayabalaji.s@sunrisesys.com | (732) 515-5373 | URL: www.sunrisesys.com
About Company
Sunrise Systems was founded in 1990 with a clear vision to deliver world-class staffing service solutions in all labor categories, including IT consulting and solutions; all with the commitment to provide service that exceeds expectations and become the most trusted name in the industry. More than two and a half decades later, we pride ourselves on being at the forefront of the staffing industry. Combining our deep industry expertise, insights, and global resources, we have partnered with our clients to connect them with top professionals across several different industries.
We provide cost-effective Managed Staffing Solutions, Information Technology and Information Technology Consulting Services to several Fortune 500 companies and U.S. Government agencies. We provide our clients with flexible engagement models and customized products that are budget and time specific. Understanding the challenges that every business faces, we offer our services either on-site at the clients' site or from one of our globally distributed technology centers. Our onshore and offshore development capabilities ensure that we excel at meeting customer requirements every single time.
Our collective business experience spans over two and a half decades and ranges from:
- Business, management, and technical fields
- Information technology consulting and software solutions.
- Providing strategic support for the development and long-term growth of new business ventures across several industries including but not limited to; accounting, banking, finance, and recruitment.
- Motivating technology staff and establishing partnerships with Fortune 500 companies
Sunrise Systems has a vast range of competence in:
- Design, development, and support of cloud-based solutions from simple to highly complexed
- Database administration of multi-platform applications, complex databases, and web-based environments that include all aspects of installation, planning, maintenance, and monitoring.
- Data processing and data migration
- Application re-engineering and platform migration
- Working with the Information Systems and end-user communities at all levels to resolve issues and establish consensus.