Appeals Coordinator

Glen Allen VA 23060 Suite 125

Job Description

Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests. In some cases may be combined with Grievance Coordinator functions.
  • Maintains a caseload and monitors day to day compliance of appeal decision time frames. 
  • Reviews clinical and medical records for completeness and determines administrative or clinical appeal.  
  • Assigns reviews to physician advisers and medical directors for those requiring medical necessity reviews.
  • Enters all data related to appeals and case reviews into a database.
  • Prepares and presents information on appeals to panels second-level multi-disciplinary committee.
  • Participates in data gathering and analysis of reports regarding appeal activity as well as preparing for appeals audits, provides new employee training, monitors QI (Quality Improvement) activities of appeals department, and assists in the development of depart flows and implementations. 
  • Coordinates and distributes first, second and third level appeal request assignments.
  • Consults with managers on problem cases and interfaces with case managers, clinical supervisors, account managers and other personnel in resolving denial and appeal questions.
  • Responds to member, provider, and client telephone inquiries regarding status, process and outcome of appeals.
  • Organizes volume of work and work-flow so that performance standards and proper procedures for appeals resolution according to client requirements and state and federal regulations are addressed.

General Job Information


Appeals Coordinator



Job Family

Quality Group


United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience

Customer Service


GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


- 2+ years experience in processing appeals and/or claims.

- Experience working in a contact center environment.

- 2+ years Behavioral Health, Healthcare or Managed Care Industry experience.

- Ability to talk on the telephone and type on a computer simultaneously.

- Working knowledge Microsoft Product Suite.

- Ability and willingness to learn new software applications.

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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