Appeals Coordinator

ProCare Rx Career • Gainesville, GA

12h • Onsite

About The Position

The Appeals Coordinator is responsible for managing the appeals process for patients, ensuring that denials from insurance companies are overturned. This role involves creating patient-specific appeal letters, coordinating with healthcare providers for necessary signatures, and submitting documentation to insurance companies. The coordinator will communicate with patients, providers, and payers to gather information and maintain accurate records of all appeals. A key aspect of this role is working closely with provider office points of contact to streamline the appeals process and ensure timely submission of documents. The position also requires processing fax queues, emails, and incoming calls, adhering to authorization management thresholds, and maintaining data integrity in the CRM system. The Appeals Coordinator will also research healthcare policies, provide status updates, and contribute to improving the appeals process and training new staff. Ensuring the accuracy and quality of data entry and handling protected health information in accordance with HIPAA laws are critical. The role demands assessing and resolving client issues, working cooperatively with colleagues, and escalating issues to management as needed. Performing other assigned duties to support the business is also expected.

Requirements

• Strong understanding of medical terminology, insurance plans and authorization processes.
• Bachelor’s degree in healthcare administration, business or related field or minimum 3 year working in a healthcare setting managing or interpreting patient clinical notes or EMR files.
• Excellent written and verbal communication skills.
• Strong analytical and problem-solving skills.
• Working in a fast-paced environment for 2+ years is required.
• High level attention to detail and accuracy, with excellent investigative and research abilities.
• Strong customer service orientation.
• Ability to manage cases from multiple clientele programs and follow program business rules.
• Proficiency with data entry functions and Microsoft applications required.
• Ability to work independently and on a team.
• Excellent communication, problem solving and customer service skills.
• Strong organizational /interpersonal skills; attention to detail and the ability to multitask proficiently.
• Ability to use multiple PC monitors and navigate through several.

Nice To Haves

• Bilingual English/Spanish is a plus.
• Previous experience in healthcare appeals or related field preferred.

Responsibilities

• Create patient specific appeal letters by incorporating the reason of medical necessity for why the denial should be overturned.
• Coordinate prescriber review and signature of completed letters.
• Prepare and submit appeal documentation to insurance companies.
• Communicate with patients, healthcare providers, and insurance companies to gather necessary information.
• Work closely with provider office point of contact(s) to obtain updated information in order to create appeals, draft letters, as well as follow pharmacy workflow steps to provide a streamlined appeal process for offices and payers.
• Maintain accurate and up-to-date records of all appeals processed.
• Process fax queues, emails, answer incoming calls and adhere to all thresholds for authorization management.
• Monitor appeal deadlines and ensure timely submission of all required documents.
• Input accurate and clear data entry of call logs, important case notes and authorization details into CRM system.
• Collaborate with internal departments to ensure comprehensive appeal support.
• Research and stay current with changes in healthcare policies and regulations.
• Provide status updates and resolution outcomes to involved parties.
• Develop and implement strategies to improve the appeals process.
• Assist in training new staff members on the appeals process.
• Verify the accuracy and quality of data entry within authorizations prior to submission.
• Safeguard, protect, and always demonstrate proper handling of protected health information in accordance with all HIPAA laws and company policies/procedures.
• Assess, prioritize and resolve client issues using good listening and comprehension skills.
• Works cooperatively and provides coverage for responsibilities of co-workers when assigned or as the need arises.
• Demonstrate working knowledge of all facets of the role, relevant regulations & organizational and departmental policies & procedures.
• Escalate issues to management as appropriate.
• Perform other duties as assigned to support the business.

Benefits

• Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.
• Paid vacation and holiday pay.
• Employee Wellness Program.
• 401(k) with a company match.
• Employee Assistance Program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 101-250 employees