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Appeals Intake Coordinator

Apex Systems, Inc • Grand Rapids, MI • 3h ago

Job Description:

JOB DESCRIPTION

Job Title: Appeals Intake Coordinator

100% Remote

Expenses allowed: no

Corewell Health Equipment to be Provided.

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:

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

Qualifications:

Required High School Diploma or equivalent

Preferred Associate's Degree

1 year of relevant experience Health insurance/managed care experience performing Appeals and Grievances functions Required

Must Have

Attention to detail

Fax processing

Learning new processes

Manual intake work

Nice To Have

Experience with EPIC{target="_blank" rel="noopener noreferrer"}

Experience with Health Plan Appeals{target="_blank" rel="noopener noreferrer"}

Everforth Apex is a world-class IT services company that serves thousands of clients across the globe. When you join Everforth Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRateds Best of Staffing in Talent Satisfaction in the United States and Great Place to Work in the United Kingdom and Mexico.

Everforth Apex uses a virtual recruiter as part of the application process. Click here{target="_blank" rel="noopener"} for more details. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Everforth Apex and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at https://www.apexsystems.com/privacy-policy{target="_blank" rel="noopener"}

Everforth Apex Benefits Overview: Everforth Apex offers a range of supplemental benefits, including medi

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