Stefanini Group is hiring!
Stefanini is looking for Appeals Intake Coordinator-Remote 100%
For quick apply, please contact Rahul Kumar; Ph: 248 936 5060
Rahul.kumar@stefanini.com
W2 Candidates Only!
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:
Triaging of incoming appeals & grievancesCorresponds with members, providers and regulators regarding decisions and actionsCommunicate, collaborate and cooperate with internal and external stakeholders.Adheres to compliance and regulatory requirementsComplies with HIPAA regulationsSupports department-based goals which contribute to the success of the organizationReasoning ability to identify and define problems, collect data/information, establish facts, and draw valid conclusions, makes decisions and implements changes related to Federal regulationsQualifications:
Required High School Diploma or equivalentPreferred Associate's Degree1 year of relevant experience Health insurance/managed care experience performing Appeals and Grievances functions Required
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Stefanini takes pride in hiring top talent and developing relationships with our future employees. Our talent acquisition teams will never make an offer of employment without having a phone conversation with you. Those face-to-face conversations will involve a description of the job for which you have applied. We also speak with you about the process including interviews and job offers.
About Stefanini Group:
The Stefanini Group is a global provider of offshore, onshore and near shore outsourcing, IT digital consulting, systems integration, application, and strategic staffing services to Fortune 1000 enterprises around the world. Our presence is in countries like the Americas, Europe, Africa, and Asia, and more than four hundred clients across a broad spectrum of markets, including financial services, manufacturing, telecommunications, chemical services, technology, public sector, and utilities. Stefanini is a CMM level 5, IT consulting company with a global presence. We are CMM Level 5 company