Appeals Coordinator

Phoenix AZ 85034

Job Description

Coordinate appeals process as assigned, attends to risk management issues associated with utilization management appeal requests.

The Appeals Coordinator will work closely with the appeals unit clinical review staff, known as Appeal Nurses, to ensure timely and accurate processing of requests for post-determination review. Responsibilities/Duties:
•Assemble and forward clinical and administrative case documentation to clients.
•Assist in maintaining timeliness requirements for the review of determination requests.
•Attach faxed medical records to the appropriate Informa authorization record.
•Communicate directly with health plan designees, providers, members, and internal clinical and non-clinical staff.
•Maintain administrative responsibilities for the appeals unit.
•Maintain daily and monthly tracking logs.
•Receive case documentation from health plan representatives, providers, and members and initiate the appropriate review process.
•Review clinical documentation to determine completeness of information for review.
•Perform additional duties as needed.

QUALIFICATIONS
•High School diploma required
•Experience in a healthcare setting (hospital, physician office, health plan) required. At least six months experience as an authorization representative in a utilization management call center
•Experience with automated databases and standard PC business software applications required.
•Experience with reimbursement instruments (standard claim forms) and medical claims handling (provider or payor) preferred.
•Knowledge of industry terminology (CPT and ICD-9 codes) preferred
•Outstanding verbal communication skills, and proven track record in effective customer services relations required
•Excellent organizational and office administrative skills required
•Excellent written communications required
•Strong attention to detail required
•Microsoft Office suite experience with Excel experience preferred
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General Job Information

Title

Appeals Coordinator

Grade

18

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

5/9/2019

Date Requisition Created

5/6/2019

Minimum Qualifications

Education

High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Experience in customer interactions and detailed review of health related materials.
  • Strong interpersonal skills and attention to detail.
  • Ability to organize work and seek help on tasks where needed.
  • Strong writing and proofing skills required ensuring documents meet standards and are accurate.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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