Appeals Intake Coordinator

Rate: $19-$21/hour – 100% Remote

About the role

The Appeals Intake Coordinator processes incoming member and provider Medicare appeals and grievances. This role involves screening complaints and appeals for urgency, benefit or medical necessity issues, and assigning them to the appropriate analyst. The coordinator may assist in investigations, documentation gathering, correspondence, and auditing activities to promote quality member care and customer service satisfaction.

Responsibilities

• 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.

Requirements

• High School Diploma or equivalent required.
• Minimum of one (1) year of health insurance or managed care experience performing Appeals and Grievances functions.

Skills

• 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.
• Proficiency with Microsoft Office applications.
• Experience with Health Edge, Epic, and/or Facets preferred.