Medical Insurance Appeals Coordinator
Burr Ridge, IL
$20 - $22
Job Description: Appeals Coordinator (Hybrid Position)
Our client, a leading company specializing in non-invasive skin cancer treatment, is seeking an experienced and detail-oriented Appeals Coordinator to join their team. This is a hybrid position, allowing you to work from home two days per week and spend the other three days in our Burr Ridge office. As an Appeals Coordinator, you will play a crucial role in investigating and resolving complex patient and insurance provider complaints related to enrollment and claims, medical appeals, and provider payment disputes within the healthcare industry.
Appeals Investigation: Investigate and resolve patient and insurance provider complaints, conducting in-depth reviews of clinical information and nationally recognized criteria to determine the need for requested services.
Case Review: Prepare detailed reviews of cases that do not meet the criteria for requested services, ensuring accurate and comprehensive documentation.
Data Analysis and Reporting: Gather, analyze, and report all information related to appeals, providing clear and concise insights to relevant stakeholders.
Communication and Outreach: Write accurate letters and other client-facing communications, conduct outreach to determine appeal statuses, determinations, and explanations, and communicate effectively with members, providers, and customers.
Appeals Meeting: Schedule and run appeals meetings, facilitating discussions among relevant parties to reach resolutions.
Provider Education: Educate providers, members, attorneys, and other stakeholders involved in the appeals process on relevant procedures and requirements.
Administrative Tasks: Oversee administrative tasks, including settling billing issues and maintaining organized appeal files.
- 1-3 years of claims processing experience in the health insurance industry, with a focus on customer service and call center operations.
- Experience in aged claims management and grievance and appeals processing is highly desirable.
- Excellent organizational skills and attention to detail to handle multiple cases simultaneously.
- Strong communication and customer service skills to interact effectively with various stakeholders.
- Critical thinking skills to assess each unique case and apply appropriate appeal procedures.
- Knowledge of legal and federally mandated rules regarding claims processing and appeals.
- Ability to work independently, handle interruptions, and multitask effectively.
- Proficient in filing and maintaining organized logs for all appeals.
- Position: Appeals Coordinator (Hybrid)
- Location: Work from home two days per week, and three days in Burr Ridge office.
- Salary: Competitive, up to $22.00 per hour.
- Benefits: Medical, Dental, and Life Insurance provided.
- Fun and positive work environment with opportunities for growth and development.
If you have the relevant experience and a keen eye for detail, we invite you to apply for the position of Appeals Coordinator with our dynamic and growing healthcare device company. Join our team in making a difference in the lives of patients and healthcare providers across the country.
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