Complaints & Appeals Intake Coordinator (Must reside in Arizona)

CVS Health

1d•Remote

About The Position

The Complaints & Appeals Intake Coordinator prepares information and reports needed to address matters regarding complaints, appeals, and grievances. This person carries out policies, procedures, and programs to ensure compliance with federal and/or state regulations.

Requirements

1-2 years of experience in claims, data entry, and/or healthcare.
Must reside in Arizona.

Nice To Haves

Working knowledge of problem solving and decision-making skills.
Previous experience with DAG and QNXT.
Strong reading and writing skills, ensuring documents meet standards and are accurate.
Excellent organizational skills.
Experience in customer interactions and review of health-related materials.
Strong interpersonal skills.
Strict attention to detail.
Self-motivated and able to work independently.

Responsibilities

Review, interpret, and process appeals and grievances filed by patients, escalating more complex issues and concerns to management for review and follow-up.
Perform patient and insurance report analysis and identify any trends or issues that need to be addressed.
Conduct reviews of decisions and case files to determine if there are any errors or anomalies in the application of law or evidence.
Draft and send appeal decision letters, conducting detailed follow-up for timely and thorough follow-up and resolution.
Review billing and coding for all current and new medical service lines for accuracy and consistency.
Document patient billing questions and concerns, subsequently inputting all detailed notes and records into the company database.
Prepare educational materials, training programs, and presentations to enhance understanding of the appeals and grievances process.
Coach junior colleagues on best practices and standard operating procedures for handling complaints and appeals.
Assist with the training of junior-level staff to promote the development of departmental capabilities.
Perform other duties as needed.