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Appeals Coordinator
Ref No.: 18-14521
Location: Maryland Heights, Missouri
Job Title-Appeals Coordinator
Job Location-Maryland Heights,MO 
Job Duration-3+ months contract position 
Job Description:
  • Description:

    ESSENTIAL FUNCTIONS:

    - Reviews clinical and medical records for completeness and determines if the requestor is asking for an administrative/clinical appeal or is disputing a claim denial/payment.    

    - Enters all data related to appeals and case reviews into a database; setting up the appeal or claim dispute for review by a care coordinator or Care manager

    - Consults with managers on problem cases to ensure correct processing/routing of medical records 

    - Makes some outbound calls to requestor for clarification or to let them know we are not delegated for their appeal request.

    - Organizes volume of work and work-flow so that performance standards and proper procedures for appeals resolution according to client requirements and state and federal regulations are addressed.

    Strong attention to detail and ability to organize work by using strong critical thinking skills

    - Receive, sort, date stamp, scan and file daily inbound mail

    - Print, copy, stuff envelopes and deliver daily mail to mail room by 4:00pm CST

    - File hard copy medical records (Client has to keep the medical records for one month so the candidate will need to keep track of the filing and will purge/shred the medical records that are a month old. This is ongoing) . 

    -Physically load old hard copy records on a cart and get them to the shredder.  

  • Requirements/Certifications:

    Additional requirements:

    - Must have steady work history

    - 2-3 years' experience processing clinical/claim appeals preferred

    - Must be computer savvy and be proficient in MS Office, especially Outlook

    - 2-5 years in processing claims and/or appeals in a medical or health plan environment

    - Strong multi-tasking skills needed and ability to prioritize tasks

    - Excellent customer service and communication skills 

    - Critical thinking and attention to detail is a must

    - Able to work in a 'fast paced' environment/job

     

    Duration: TEMP TO HIRE

    Education: HS or GED required

    Shift: 1st shift with some flexibility with in time (start as early as 6am or 7am) 8.5 hour day with 30 minute lunch. Some OT and weekends may be required