Appeals Coordinator

Position Requirement:

Research and provide resolution to issues such as claim denials, member and provider complaints, and reconsideration and redetermination requests Review and respond to complaints, grievances and appeals within the stated time frame for each request Ensure 95% compliance with the Center for Medicare and Medicaid Services (CMS) guidelines is met by adhering to all state and federal regulations Analyze and resolve customer inquiries by adhering to CMS guidelines and internal policies and procedures Actively communicate with other associates to guarantee accurate and timely responses to inquiries involving internal/external customer needs Be proactive in educating members, providers and others about plans appeal/grievance process, plan terminations, contract terminations and benefit summary Certify that providers and members are reimbursed accordingly using Medicare reimbursement policies and procedures Requirements: Work Type: Full Time