Demo

Appeals Coordinator (Work From Home - Pennsylvania resident)

Geisinger
Danville, PA Remote Full Time
POSTED ON 1/28/2025
AVAILABLE BEFORE 2/27/2025
  • Prepares and facilitates Member appeals, complaints and grievances by communicating directly with Members, their Representatives, Vendors and Medical Providers and their Representatives to obtain the necessary information to complete the appeal process successfully within the time period allowed by regulation.
  • Investigates the full details of the appeal and complaints and grievances by consulting with, but not limited to, health care providers, legal services, internal medical staff and administration.
  • Provides timely and accurate documentation of all communications with involved parties within both the individual case file and departmental tracking database.
  • Ensures that all complaint, appeal and grievance time frames are met as dictated by guidelines set forth by the Department of Labor (DOL), the Department of Health (DOH), the Department of Insurance (DOI), the National Committee for Quality Insurance (NCQA), and the Centers for Medicare and Medicaid Services (CMS).
  • Implements regulatory changes to current practices, policies and procedures within the Department.
  • Maintains a complete and accurate database via departmental software for reporting and tracking and trending purposes.
  • Conducts regular audits of own files and data entry to ensure timely, accurate and appropriate documentation.
  • Coordinates activities for review committees and educational sessions with other Health Plan departments to ensure overall compliance is maintained.
  • Acts as the primary resource regarding the complaint, appeal and grievance processes to all other Health Plan and external entities, communicating with all entities involved throughout the appeals and grievance process.
  • Maintains strict compliance with all applicable laws and regulations set forth by the Federal and State regulatory bodies, continually reviewing updates as pertains to regulatory changes and implement those changes within current departmental practices, policies and procedures.
  • Makes suggestions for policies and procedures covering all regulatory and accreditation standards for all lines of business.


Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.


*Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

Qualifications:

Internet requirements:

Employee required to have/supply: Cable modem, (high speed, only - No DSL or Wireless Cellular Service or Satellite Service) The minimum requirement is:

  • •25 MBPS UP
  • •75 MBPS DOWN
  • •<150 ms Ping Required
  • •<30ms Jitter Required

Computer must be connected to the internet via Ethernet cable; wifi is not permitted unless a Virtual Private Network (VPN) is used for the wifi connection

If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right. Surveys & Data Sets

What is the career path for a Appeals Coordinator (Work From Home - Pennsylvania resident)?

Sign up to receive alerts about other jobs on the Appeals Coordinator (Work From Home - Pennsylvania resident) career path by checking the boxes next to the positions that interest you.
Income Estimation: 
$48,731 - $60,363
Income Estimation: 
$55,490 - $70,607
Income Estimation: 
$49,313 - $64,855
Income Estimation: 
$49,126 - $60,591
Income Estimation: 
$77,899 - $100,402
Income Estimation: 
$91,142 - $116,690
Income Estimation: 
$80,876 - $132,043
Income Estimation: 
$48,731 - $60,363
Income Estimation: 
$55,490 - $70,607
Income Estimation: 
$49,313 - $64,855
Income Estimation: 
$49,126 - $60,591
Income Estimation: 
$87,788 - $104,837
Income Estimation: 
$70,647 - $86,374
Income Estimation: 
$123,613 - $165,638
Income Estimation: 
$69,116 - $84,792
Income Estimation: 
$58,078 - $76,693
Income Estimation: 
$73,707 - $95,263
Income Estimation: 
$80,876 - $132,043
Income Estimation: 
$77,899 - $100,402

Sign up to receive alerts about other jobs with skills like those required for the Appeals Coordinator (Work From Home - Pennsylvania resident).

Click the checkbox next to the jobs that you are interested in.

  • Document Archiving Skill

    • Income Estimation: $52,584 - $79,446
    • Income Estimation: $54,253 - $71,534
  • Health Care Administration Skill

    • Income Estimation: $37,053 - $46,682
    • Income Estimation: $39,690 - $49,584
View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

Job openings at Geisinger

Geisinger
Hired Organization Address Scranton, PA Full Time
Assists repairmen by delivering tools and materials to the job site, cleaning up job sites and returning tools and mater...
Geisinger
Hired Organization Address Danville, PA Full Time
Oral Medicine and Maxillofacial Surgery- Geisinger The Department of Oral and Maxillofacial Surgery at Geisinger, a nati...
Geisinger
Hired Organization Address Lewistown, PA Full Time
Responsible for checking patients in for appointments and accurately verifying demographics. Assures all check-in proced...
Geisinger
Hired Organization Address Scranton, PA Full Time
Benefits of working at Geisinger: Full benefits (health, dental and vision) starting on day one Three medical plan choic...

Not the job you're looking for? Here are some other Appeals Coordinator (Work From Home - Pennsylvania resident) jobs in the Danville, PA area that may be a better fit.

Office Coordinator

84 Lumber Company, Bloomsburg, PA

AI Assistant is available now!

Feel free to start your new journey!