Appeals Coordinator
About The Position
At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. Position Summary: Responsible for reviewing, researching, and resolving appeals. Escalates complex appeals as needed. Ensures compliance with all applicable regulations, standards, timelines, policies, and guidelines.
Requirements
- High School or equivalent
- 1 + years Appeals related experience or the knowledge, skill, abilities to succeed in the role
- Strong learning agility and enthusiastic about developing new skills
- Ability to interact professionally and maintain confidentiality and high ethical standards
- Ability to multi-task, 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
Responsibilities
- Reviews, evaluates, documents, and tracks appeal documents.
- Follows request through resolution by established processes and procedures, and within established time standards.
- Creates, composes, and provides quality written responses (applying the appropriate composition, grammar, punctuation, and spelling) to appeals request within established time standards.
- Helps identify areas of improvement for self and the department.
- Prepares case files for Independent Review Entities or other levels of the Appeals process.
- Communicates with members and providers on appeal resolution.
- Performs peer QA of appeal notification letters.
- Ensures compliance with all state and federal regulations (Center for Medicare and Medicaid Services, National Committee for Quality Assurance) and guidelines with day to day activities.
Benefits
- Medical, Vision and Dental Plans
- Tax-Advantage Savings Accounts (FSA & HSA)
- Life Insurance and Disability Insurance
- Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
- Employee Assistance Program
- 401k with company match
- Employee Resource Groups
- Employee Discount Program
- Learning and Development Opportunities
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
501-1,000 employees
