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Provider Appeals Coordinator

VIVA Health

Birmingham, AL

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JOB DETAILS
SKILLS
Centers for Medicare and Medicaid Services (CMS), Communication Skills, Computer Skills, Customer Support/Service, Disability Insurance, Employee Assistance Plan, Flexible Spending Accounts, Health Maintenance Organization (HMO), Health Plan, Healthcare, Healthcare Management, Healthcare Quality, Healthcare Reimbursement, High School Diploma, Life Insurance, Managed Care, Medicare, Microsoft Access Database, Microsoft Excel, Microsoft Word, Organizational Skills, Presentation/Verbal Skills, Training Program, Training/Teaching, Tuition Fees, Work From Home, Writing Skills
LOCATION
Birmingham, AL
POSTED
2 days ago
Provider Appeals Coordinator

Location: Birmingham, AL

Work Schedule: Hybrid schedule with regular onsite presence at the VIVA HEALTH corporate office and some work-from-home opportunities.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

  • Comprehensive Health, Vision, and Dental Coverage
  • 401(k) Savings Plan with company match and immediate vesting
  • Paid Time Off (PTO)
  • 9 Paid Holidays annually plus a Floating Holiday to use as you choose
  • Tuition Assistance
  • Flexible Spending Accounts
  • Healthcare Reimbursement Account
  • Paid Parental Leave
  • Community Service Time Off
  • Life Insurance and Disability Coverage
  • Employee Wellness Program
  • Training and Development Programs to develop new skills and reach career goals
  • Employee Assistance Program
See more about the benefits of working at Viva Health -

Job Description

The Provider Appeals Coordinator is responsible for processing written provider appeals for participating VIVA HEALTH and VIVA Medicare Plus providers as well as non-participating providers for commercial plan members. This position assists with and participates in meetings of the Provider Appeals Committee. This position is responsible for documenting the end-results of the appeals process.

Key Responsibilities
  • Review written appeals upon receipt. Forward non-par Medicare appeals to the Medicare Member Appeals and Grievances department.
  • Research provider appeals and present findings in a concise manner to the Provider Appeals Committee.
  • Effectuate the Committee's decisions with regard to claims reprocessing or provider outreach.
  • Maintain an accurate log of all incoming provider appeals and work efficiently to close cases accurately and within required time frames.
REQUIRED:
  • High School Diploma or GED
  • 1+ years' experience working for a managed care company/health plan in customer service, claims, or appeals
  • Excellent written and oral communication skills are essential
  • Proficient in standard office software (Excel, Word, Access)
  • Ability to perform tasks with little supervision
  • Basic computer skills
PREFERRED:
  • Some college
  • 1+ years' experience with DST system
  • Experience in the managed healthcare industry
  • Advanced computer skills


Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

About the Company

V

VIVA Health