Appeals Coordinator-Magellan RX Management

Orlando FL 32812

Job Description

The role of the Appeals Intake/Coordinator is to be responsible for assessing, and outreaching with both verbal and written communication to provider and account. Documents all appeal requests within the Magellan RX division. The appeals information may vary depending on the individual account. Will support the appeal program and testing as necessary between any account and the Magellan RX division.
• Researches, validates and coordinates all required appeal information for retrospective and existing cases per accounts as assigned.
• Point person, liaison between Magellan Intake team and the account specific appeals department.
• Performs verbal/written outreach to provider and/or member explaining the appeals process and next steps.
• Performs verbal outreach and correspondence with the Provider to obtain specific additional medical information required to make a determination.
• Work efficiently, independently and as a member of team.
• Maintains a case load of appeal requests.
• Effectively communicates results of any appeal or testing scenarios.
• Knowledge of benefit plans and compliance guidelines.
• Determination of request and criteria as outlined by each account.
• Provides coordination along with providing a high level of accuracy and quality in producing materials, and interactions with providers, members and colleagues.
• Create and maintain spreadsheets for individual accounts, as applicable to any appeal information. Documentation and data entry specific to the appeals program, which includes entering information into external applications. Demonstrates a working knowledge of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
• Accurately tests any new functions/tasks within the primary application tool. Correctly interprets anticipated scenarios into real scenarios and documents any discrepancies. Uses critical thinking skills to develop and creative solutions to complicated issues. Applies information from a variety of sources, spreadsheets, applications and reports.
• Participates in all training sessions related to specific benefit software/applications. Other responsibilities as assigned by manager.
Requirements:
Education: Associates Degree and 1-3 yrs. of experience.
Experience:
• Previous experience in customer service.
• Excellent written and verbal communication skills, organization skill and the ability to handle multiple tasks.
• Ability to carefully follow processes in sequential order.
• Knowledge of managed health care principles and call center operations.
• Ability to work under timelines and meet standards.
• Team and Project management skills.
• Uses critical thinking skills to develop creative solutions to complicated issues.
• Knowledge of benefit plans and compliance guidelines.
• Computer Skills: Knowledge of computer platforms and applications of Microsoft Office and Excel spreadsheets.
Preferred Computer Skills: Knowledge of computer platforms and applications of Microsoft Office and Excel spreadsheets.
Qualifications: Current experience with internal applications and processes.

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General Job Information

Title

Appeals Coordinator-Magellan RX Management

Grade

18

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

11/21/2019

Date Requisition Created

11/21/2019

Work Experience

Customer Service

Education

Associates, GED (Required), 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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