Appeals Coordinator

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Position:Appeals Coordinator

Position Summary:Responsible for reviewing, researching, and resolving appeals. Escalates complex appeals as needed. Ensures compliance with all applicable regulations, standards, timelines, policies, and guidelines.

Job Description:

Primary Responsibilities

• Reviews, evaluates, documents, and tracks appeal documents.  Follows request through resolution by established processes and procedures, and within established time standards.
• Creates, composes, and provides quality written responses (applying the appropriate composition, grammar, punctuation, and spelling) to appeals request within established time standards.
• Helps identify areas of improvement for self and the department.
• Prepares case files for Independent Review Entities or other levels of the Appeals process.
• Communicates with members and providers on appeal resolution.
• Performs peer QA of appeal notification letters.
• Ensures compliance with all state and federal regulations (Center for Medicare and Medicaid Services, National Committee for Quality Assurance) and guidelines with day to day activities.

Qualifications

• High School or equivalent
• 1 + years Appeals related experience or the knowledge, skill, abilities to succeed in the role
• Strong learning agility and enthusiastic about developing new skills
• Ability to interact professionally and maintain confidentiality and high ethical standards
• Ability to multi-task, meet deadlines, and adapt to changing priorities
• Solid oral and written communication skills
• Good computer skills, specifically with Microsoft Word, Excel, PowerPoint, and Outlook
• Solid attention to detail

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions
• Work weekends and company holidays as needed based on business regulatory requirements

Disclaimer

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

#LI-Remote

Lumeris is an EEO/AA employer M/F/V/D.

The hiring range for this position is:

$39,000.00-$48,150.00

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our Careers Page.

Member Facing Position: No- Not Member or Patient Facing Position

Location:Remote, USA

Time Type:Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment. Apply