Provider Appeals Specialist I

Viva Health•Birmingham, AL

12h•Onsite

About The Position

The Provider Appeals Specialist is responsible for the intake of all appeals received from contracted and non-contracted providers in a timely and accurate manner. This role will assist in processing the intake of appeals from mail, email, fax and other electronic means and is responsible for ensuring appeals are entered correctly and timely into the department’s database system. This individual will assist in the coordination of a timely resolution according to federal and state guidelines and VIVA HEALTH policies and procedures. This position will also assist with intake of Medicare appeals and grievances received from members and non-contracted providers.

Requirements

High School Diploma or GED
1+ years' experience in managed care, health care customer service, or appeals and grievances
Excellent written and verbal communication skills, interpersonal skills, organization skills, and the ability to handle multiple tasks
Ability to carefully follow processes in sequential order
Ability to meet established productivity, schedule adherence, and quality standards
Attention to detail and ability to meet strict deadlines
Ability to learn and use various computer platforms and ability to use applications of Microsoft Office
Ability to use critical thinking skills to develop solutions to non-clinical issues using fact-based decision making
Ability to work occasional planned and unplanned overtime to meet deadlines with minimal supervision

Nice To Haves

Associate's Degree
1+ years' experience processing Medicare appeals and grievances
Knowledge of Medicare regulations
Experience with administrative and/or coordinator positions with exposure to protected health information (PHI)

Responsibilities

Record appeals in the department’s system(s) timely and accurately, ensuring all necessary documentation is uploaded with the case.
Classify contracted and non-contracted provider appeals according to federal and state regulations, as well as internal and organizational policies and procedures.
Route appeals to other departments as needed for investigation to resolve the cases.
Route other incoming mail, email and faxes to the appropriate departments in a timely manner.
Assist with recording Medicare appeals and grievances requests in the department’s system(s) timely and accurately, ensuring all necessary documentation is uploaded with the case.
Be available to work 8 a.m. to 5 p.m. Monday through Friday at the Company’s corporate headquarters, plus overtime and weekends as required.