Appeals Coordinator

Job Description: Appeals Coordinator (Hybrid Position)

Our client, a leading company specializing in non-invasive skin cancer treatment, is seeking an experienced and detail-oriented Appeals Coordinator to join their team. This is a hybrid position, allowing you to work from home two days per week and spend the other three days in our Burr Ridge office. As an Appeals Coordinator, you will play a crucial role in investigating and resolving complex patient and insurance provider complaints related to enrollment and claims, medical appeals, and provider payment disputes within the healthcare industry.

Responsibilities:

1. Appeals Investigation: Investigate and resolve patient and insurance provider complaints, conducting in-depth reviews of clinical information and nationally recognized criteria to determine the need for requested services.

2. Case Review: Prepare detailed reviews of cases that do not meet the criteria for requested services, ensuring accurate and comprehensive documentation.

3. Data Analysis and Reporting: Gather, analyze, and report all information related to appeals, providing clear and concise insights to relevant stakeholders.

4. Communication and Outreach: Write accurate letters and other client-facing communications, conduct outreach to determine appeal statuses, determinations, and explanations, and communicate effectively with members, providers, and customers.

5. Appeals Meeting: Schedule and run appeals meetings, facilitating discussions among relevant parties to reach resolutions.

6. Provider Education: Educate providers, members, attorneys, and other stakeholders involved in the appeals process on relevant procedures and requirements.

7. Administrative Tasks: Oversee administrative tasks, including settling billing issues and maintaining organized appeal files.

Qualifications:

• 1-3 years of claims processing experience in the health insurance industry, with a focus on customer service and call center operations.
• Experience in aged claims management and grievance and appeals processing is highly desirable.
• Excellent organizational skills and attention to detail to handle multiple cases simultaneously.
• Strong communication and customer service skills to interact effectively with various stakeholders.
• Critical thinking skills to assess each unique case and apply appropriate appeal procedures.
• Knowledge of legal and federally mandated rules regarding claims processing and appeals.
• Ability to work independently, handle interruptions, and multitask effectively.
• Proficient in filing and maintaining organized logs for all appeals.

Job Details:

• Position: Appeals Coordinator (Hybrid)
• Location: Work from home two days per week, and three days in Burr Ridge office.
• Salary: Competitive, up to $22.00 per hour.
• Benefits: Medical, Dental, and Life Insurance provided.
• Fun and positive work environment with opportunities for growth and development.

If you have the relevant experience and a keen eye for detail, we invite you to apply for the position of Appeals Coordinator with our dynamic and growing healthcare device company. Join our team in making a difference in the lives of patients and healthcare providers across the country.