What are the responsibilities and job description for the Medicare Appeals Intake position at Priority Health?
Job Summary
The Appeals intake coordinator position is focused on the processing of incoming member and provider Medicare appeals and grievances. This team member will screen incoming complaints and appeals for level of urgency, benefit or medical necessity issues and other appropriate inquiries. This team member will assign the incoming concern to the appropriate analyst and may assist in investigations, documentation gathering, and correspondence as needed. This team member may also participate in auditing and monitoring activities as assigned. This team member will promote quality member care and customer service/satisfaction.
This team member will interact with Customer Service, Utilization Management, Medical Directors, and other internal teams as necessary to effectively triage incoming complaints and appeals.
Essential Functions
Required
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
SITE - Priority Health - 1239 E Beltline - Grand Rapids
Department Name
PH - Grievance And Appeals Medicare
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8:00 a.m. to 5:00 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
The Appeals intake coordinator position is focused on the processing of incoming member and provider Medicare appeals and grievances. This team member will screen incoming complaints and appeals for level of urgency, benefit or medical necessity issues and other appropriate inquiries. This team member will assign the incoming concern to the appropriate analyst and may assist in investigations, documentation gathering, and correspondence as needed. This team member may also participate in auditing and monitoring activities as assigned. This team member will promote quality member care and customer service/satisfaction.
This team member will interact with Customer Service, Utilization Management, Medical Directors, and other internal teams as necessary to effectively triage incoming complaints and appeals.
Essential Functions
- Triaging of incoming appeals & grievances
- Corresponds with members, providers and regulators regarding decisions and actions
- Communicate, collaborate and cooperate with internal and external stakeholders.
- Adheres to compliance and regulatory requirements
- Complies with HIPAA regulations
- Supports department-based goals which contribute to the success of the organization
- Reasoning ability to identify and define problems, collect data/information, establish facts, and draw valid conclusions, makes decisions and implements changes related to Federal regulations
Required
- High School Diploma or equivalent
- 1 year of relevant experience Health insurance/managed care experience performing Appeals and Grievances functions
- Associate's Degree
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance, pet insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
SITE - Priority Health - 1239 E Beltline - Grand Rapids
Department Name
PH - Grievance And Appeals Medicare
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8:00 a.m. to 5:00 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
