Appeals Coordinator
New
G
Geisinger Health PlanHealth Insurance
Work from home (Pennsylvania)Full-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- Minimum of 5 years-Relevant experience
- Required Skills
- DocumentationComplianceData entry
Requirements
- High School Diploma or equivalent (GED).
- Minimum of 5 years of relevant experience.
- Relevant experience may be a combination of related work experience and degree (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).
- Strong communication skills.
- Proven ability to multitask.
- Ability to work independently.
- Knowledge of health insurance appeals and grievance processes.
- Understanding of regulatory standards (DOL, DOH, DOI, NCQA, CMS).
- Ability to travel as required.
Responsibilities
- Communicate directly with members, representatives, vendors, and medical providers to facilitate the appeal process.
- Investigate appeal and grievance details by consulting with healthcare providers, legal services, and internal medical staff.
- Document all communications accurately in individual case files and the departmental tracking database.
- Ensure complaint and appeal time frames are met per DOL, DOH, DOI, NCQA, and CMS guidelines.
- Implement regulatory changes into current departmental practices, policies, and procedures.
- Maintain complete database records for reporting, tracking, and trending purposes.
- Conduct regular audits of files and data entry to ensure accuracy and compliance.
- Coordinate review committee activities and educational sessions with other departments.
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