Appeals Coordinator

Company: Manpower
Location: Durham
Posted on: March 20, 2023

Job Description:

Remote Appeals Coordinator - $25.28/hr Do you have experience working with Medical Appeals and Grievances?! If so, Manpower is looking for you to join a great client of ours in the NC area! Don't wait--- apply today! What's in it for you?

• Payrate - $25.28/hr
• 6 month contract
• Paid training
• Full time hours
• RemoteWhat will you be doing?
  • Performs initial research and documentation of all incoming appeals and grievances.
  • Demonstrates the ability to research benefits, plan policies, provider contracts, and determine the appropriate time frames applicable to an incoming request.
  • Determines the validity of all incoming appeals and makes critical decisions to keep and work as a valid appeal or send letter back to requestor indicating the appeal is non-valid and provide rationale for the non-valid decision.
  • Provide members with education regarding appropriate submission of inquiries.
  • Provides mandated written responses to appellants of receipt of appeal, need for additional information and may provide interim responses giving notice of an extension of the appeals process to unforeseen delays, (i.e.) Acknowledgement letters and 3rd party authorizations forms, Appointment Of Representative and Waiver Of Liability forms.
  • Researches all department requests, set up, and assign cases, as well as maintain files within the unit.
  • Identifies all misrouted inquiries and handles them accordingly.
  • Provides direct feedback to Appeals Department management for identified problems.
  • Identifies additional tasks and works independently to ensure all up front functions run smoothly, which may include scanning and imaging as required, answer member/provider questions via incoming telephone calls in a professional quality driven manner
  • Analyzes and coordinates all aspects of the appeals process to ensure compliance with our medical necessity criteria, Corporate Medical Policy, contract provisions, NC DOI, legislative and NCQA requirements.
  • Sorts, and distributes all incoming requests via direct mail, right fax and Macess in a timely efficient manner throughout the day to ensure regulatory filing requirements are met. Date stamp and initial all incoming correspondence via direct mail. What do you bring?
    • • CPC preferred- ideally strong preference.
      • Associate degree and 6 months - 1-year claims, customer service, medical office (billing, authorizations and/or patient accounting etc.), health insurance or coding experience
      • If no degree, High School Diploma and 1-3 years' claims, customer service, medical office (billing, authorizations and/or patient accounting etc.), health insurance or coding experience
      • 6 years' experience in claims, Healthcare Management and Operations, and/or customer service. Are you Interested? Stop your job search and apply today! A recruiter will be in touch within 24 hours. Share this job with friends and family and earn dollars with every successful hire. ManpowerGroup recognizes the importance of providing an accessible and barrier-free environment. We are committed to creating a welcoming, fair and inclusive environment by offering equal opportunity to access our services. At ManpowerGroup, we are committed to providing accommodations, and will work with you to meet your needs.
        

Keywords: Manpower, Durham , Appeals Coordinator, Other , Durham, North Carolina