Appeals Intake Coordinator

100% remote position. Equipment will be provided by Corewell Health.

About the Role

The Appeals Intake Coordinator is responsible for processing incoming member and provider Medicare appeals and grievances. This role involves screening complaints and appeals for urgency, benefit or medical necessity issues, and other inquiries. The coordinator assigns concerns to the appropriate analyst and may assist in investigations, documentation gathering, and correspondence. Participation in auditing and monitoring activities may also be required. The role promotes quality member care and customer satisfaction while interacting with various internal teams.

Responsibilities

• Triage incoming appeals and grievances.
• Correspond with members, providers, and regulators regarding decisions and actions.
• Communicate, collaborate, and cooperate with internal and external stakeholders.
• Adhere to compliance and regulatory requirements, including HIPAA regulations.
• Support department-based goals contributing to organizational success.
• Identify and define problems, collect data, establish facts, and draw valid conclusions to make decisions related to Federal regulations.
• Assist in investigations, documentation gathering, and correspondence as needed.
• Participate in auditing and monitoring activities as assigned.

Requirements

• High School Diploma or equivalent (required).
• Associate's Degree (preferred).
• 1 year of relevant experience in health insurance/managed care, specifically performing Appeals and Grievances functions.
• Attention to detail.
• Experience with fax processing, learning new processes, and manual intake work.

Preferred Skills

• Experience with EPIC.
• Experience with Health Plan Appeals.
• Experience with Everforth Apex.

Benefits

• Medical, dental, vision, life, and disability insurance plans.
• Employee Stock Purchase Program (ESPP).
• 401K program with company match after 12 months of tenure.
• Health Savings Account (HSA) on the HDHP plan.
• SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions.
• Corporate discount savings program and other discounts.
• On-demand training program and access to certification prep, technical and leadership courses/books/seminars after 6+ months of tenure.
• Certification discounts and association perks (e.g., CompTIA, IIBA).
• Dedicated customer service team for benefits and resources.
• Access to a certified Career Coach.