Appeals Coordinator

Lumeris

3d•$39,000 - $48,150•Remote

About The Position

The Appeals Coordinator reviews, researches, and resolves appeals, escalating complex appeals as needed. The role ensures compliance with applicable regulations, standards, timelines, policies, and guidelines. The position is remote in the United States and is not member- or patient-facing.

Requirements

High school diploma or equivalent.
At least 1 year of appeals-related experience, or the knowledge, skills, and abilities to succeed in the role.
Strong learning agility and enthusiasm for developing new skills.
Ability to interact professionally and maintain confidentiality and high ethical standards.
Ability to multitask, meet deadlines, and adapt to changing priorities.
Solid oral and written communication skills.
Good computer skills, specifically with Microsoft Word, Excel, PowerPoint, and Outlook.
Solid attention to detail.
Authorization to work in the United States; visa sponsorship is not available for this role.

Responsibilities

Review, evaluate, document, and track appeal documents, following requests through resolution according to established processes, procedures, and time standards.
Create, compose, and provide quality written responses to appeal requests within established time standards.
Identify areas for improvement for oneself and the department.
Prepare case files for Independent Review Entities or other levels of the appeals process.
Communicate with members and providers about appeal resolution.
Perform peer quality assurance reviews of appeal notification letters.
Ensure day-to-day compliance with state and federal regulations and guidelines, including those of the Centers for Medicare and Medicaid Services and the National Committee for Quality Assurance.
Escalate complex appeals as needed.

Benefits

Medical, vision, and dental plans.
Tax-advantaged savings accounts (FSA and HSA).
Life insurance and disability insurance.
Paid time off, sick time, paid leave, volunteer days, and wellness days.
Employee Assistance Program.
401(k) with company match.
Employee Resource Groups.
Employee discount program.
Learning and development opportunities.
Certain roles may qualify for performance-based incentives and/or equity, depending on position eligibility.