Admin 2 - Appeals

This is a remote opportunity providing administrative and case management support, including maintaining accurate case records, processing documentation, data entry and validation, and ensuring timely reporting and case tracking. The role serves as a point of contact for case status inquiries, supports client reporting requirements, and performs quality audits to ensure compliance with established procedures. This is a client-facing position requiring a client-specific clearance, including fingerprinting.

Responsibilities

• Type/generate letters and other documents as necessary.
• Assist in the preparation of reports.
• Create and update case files in the case management system.
• Fax and email file determination letters to interested parties.
• Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs, and health plans to input necessary information into the system.
• Respond to incoming calls from clients, health plans, providers, and enrollees regarding case status, program questions, and the appeals process.
• Perform research into invoicing issues and outreach to health plans regarding unpaid invoices.
• Enter appropriate data into computer systems and automated tracking systems.
• Aid team members with case file maintenance.
• Receive, process, and distribute incoming mail and faxes.
• Produce and maintain data reports, alerting management of inconsistencies or issues.
• Serve as a point of contact for external inquiries regarding case status.
• Prepare and disseminate case summaries to satisfy client reporting requirements.
• Validate application information against documents.
• Perform audits of own work to ensure conformance with established procedures.
• Perform other duties as assigned by management.

Requirements

• High School diploma, GED, or equivalent required.
• 2-4 years of experience required, including 2-3 years of applicable related job experience.
• Proficiency in Microsoft Suite, Adobe, and ability to accurately perform data entry.
• Excellent organizational, written, and verbal communication skills.
• Ability to perform comfortably in a fast-paced, deadline-oriented work environment.
• Ability to successfully execute complex tasks simultaneously with attention to detail.
• Ability to work as a team and independently.
• Ability to work under standards-based performance measures.
• Strong critical thinking skills.
• Ability to maintain confidentiality and security of all information processed.
• Typing speed of 40 WPM.
• Familiarity with virtual machines to access external networks.
• Ability to work a schedule between the hours of 8:00am - 5:00pm PST, Monday - Friday.

Preferred Qualifications

• Associate's Degree.
• Resident of the state of California.
• Prior experience working with sensitive information, including protected data.
• Prior experience requesting medical records and processing documentation revisions per client request.

Home Office Requirements

• Internet speed of 25mbps or higher (50 Mbps for shared connectivity).
• Minimum 5mbps upload speed.
• Connectivity via Category 5 or 6 ethernet patch cable to the home router.
• Private and secure work area with adequate power source.
• Must currently and permanently reside in the Continental US.
• Must have a smartphone for logging into Maximus systems.

Maximus will provide equipment for this position.

Pay

Hourly salary range: $21.00.