Appeals Coordinator

SOUTHWEST SERVICE ADMINISTRATORS INC • Phoenix, AZ

3d • $18 - $24

About The Position

The Appeals Coordinator is responsible for providing expertise in reviewing, researching, investigating, negotiating, and resolving both verbal & written appeals and grievances from members and providers within stringent time frames.

Requirements

• High School Diploma/GED
• Minimum of five (5) years of experience with coding certification
• Prior grievance and appeals experience preferred.
• Extensive knowledge of medical terminology, CPT Codes, ICD 9/10 and medical claim forms.
• Strong analytical and research skills with the ability to read and assess medical documentation and draw valid conclusions.
• Proficiency in interpretation of plan documents.
• Solid knowledge of MS Excel & MS Word.
• Minimum 40 WPM and 3,000 KPH proficiency
• Strong mathematical skills required
• Professional, client-focused approach to colleagues and assignments.
• Strong oral and written communication skills with exceptional attention to details.
• Ability to seek out experiences that may change perspective or provide an opportunity to learn new things.
• Strong dedication to follow-through on all tasks and assignments.
• Ability to organize, set priorities, work independently and complete multiple projects within established deadlines.
• Ability to sit for long periods of time operating a computer keyboard.

Nice To Haves

• Bilingual in English and Spanish a plus.

Responsibilities

• Appeals and Grievances Gain and maintain the understanding of the plan designs and effectively apply that knowledge.
• Maintain a comprehensive working knowledge of Policies, Procedures, Compliance Regulations, Schedule of Benefits and turnaround times across all product lines.
• Maintain an understanding of claims processing and an ability to research claims issues.
• Prepare acknowledgment and response letters to members and providers.
• Maintain case records on all complaints, grievances, and appeals.
• Identify, research and resolve claim disputes received from a variety of sources.
• Ability to multitask on multiple appeals simultaneously, prioritizing work and completing within stringent time frames.
• Prepare statistical analysis for required reporting.
• Analyze and track trends.
• Teamwork Work cooperatively with other team members
• Actively participate in team meetings and training activities.
• Perform additional responsibilities and projects as periodically assigned.

Benefits

• MEDICAL, DENTAL, VISION
• SHORT-TERM DISABILITY
• Full coverage benefits for a low weekly premium of $5 (Employee Only), $15 (for Child(ren) and $20 per week for full family or Employee/Spouse.
• COMPANY PAID supplemental dental coverage of $1,000 per year for Employee.
• COMPANY PAID LONG TERM Disability & Life/AD&D coverage.
• 401K Plan including company match up to 5%.
• COMPANY PAID additional pension plan entirely funded by the company.
• EXCEPTIONAL TIME OFF package including Paid Personal Leave (PPL) and Vacation with annual BUY BACK options!!!!
• Annual, automatic pay increases.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED