Provider Appeals Coordinator

Viva Health•Birmingham, AL

2d•Hybrid

About The Position

The Provider Appeals Coordinator is responsible for processing written provider appeals for participating VIVA HEALTH and VIVA Medicare Plus providers as well as non-participating providers for commercial plan members. This position assists with and participates in meetings of the Provider Appeals Committee. This position is responsible for documenting the end-results of the appeals process.

Requirements

High School Diploma or GED
1+ years’ experience working for a managed care company/health plan in customer service, claims, or appeals
Excellent written and oral communication skills are essential
Proficient in standard office software (Excel, Word, Access)
Ability to perform tasks with little supervision
Basic computer skills

Nice To Haves

Some college
1+ years’ experience with DST system
Experience in the managed healthcare industry
Advanced computer skills

Responsibilities

Review written appeals upon receipt.
Forward non-par Medicare appeals to the Medicare Member Appeals and Grievances department.
Research provider appeals and present findings in a concise manner to the Provider Appeals Committee.
Effectuate the Committee’s decisions with regard to claims reprocessing or provider outreach.
Maintain an accurate log of all incoming provider appeals and work efficiently to close cases accurately and within required time frames.