Sr Coordinator, Complaints & Appeals Operations
About The Position
This position supports the daily processing of appeals in the Commercial Member Clinical Appeals (CMCA). Job functions include but not limited to, completing appeals determination letters, intake and launching of expedited requests, verbal expedited notifications/determinations, updating systems, completing reporting as necessary, supporting the panel hearing process, working collaboratively with clinical support staff (Medical Directors, Nurses, Providers, etc.), triage of faxes, and movement of cases in the Complaints and Appeals Tracking System (CATS). All work is to be handled in compliance of turnaround times and regulatory standards.
Requirements
- Familiar with Medical Terminology
- Strong written and verbal communication
- Ability to multi-task
- Proficient in basic computer skills including Microsoft Office Suite
Nice To Haves
- Knowledge of appeals process/appeals experience
- Prior experience working in a medical setting
Responsibilities
- Completing appeals determination letters
- Intake and launching of expedited requests
- Verbal expedited notifications/determinations
- Updating systems
- Completing reporting as necessary
- Supporting the panel hearing process
- Working collaboratively with clinical support staff (Medical Directors, Nurses, Providers, etc.)
- Triage of faxes
- Movement of cases in the Complaints and Appeals Tracking System (CATS)
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
