Appeals Coordinator
New
J
JobgetherHealthcare appeals
Based in BrazilContract
Salary not disclosed
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Job Details
- Required Skills
- Microsoft OfficeCustomer serviceWritingData entry
Requirements
- High school diploma or GED required; an associate degree is preferred.
- Previous customer service experience, particularly involving direct customer interactions and detailed documentation.
- Experience with data entry and case management.
- Strong letter-writing, writing, proofreading, and document-review skills.
- Proficiency with Microsoft Office and Microsoft Suite applications.
- Ability to review and understand health-related materials and handle sensitive information professionally.
- Strong interpersonal and communication skills for interacting with members, providers, clients, and internal stakeholders.
- Ability to manage multiple cases, priorities, and deadlines effectively.
- Ability to recognize when assistance is needed and seek support on complex or unfamiliar tasks.
- Healthcare experience is a plus.
- Typing speed of approximately 50 words per minute is preferred.
Responsibilities
- Maintain an assigned caseload and monitor appeal decision timelines and procedures.
- Review medical and clinical records for completeness and determine the appropriate appeal pathway.
- Coordinate first-, second-, and third-level appeal assignments and assign medical necessity reviews to physician advisers and medical directors.
- Enter appeal and case review information into databases and maintain complete documentation.
- Prepare and present appeal information to panels and multidisciplinary committees.
- Gather and analyze appeal activity data and support internal and external audits.
- Participate in quality improvement activities and help develop and implement department workflows.
- Support training for new employees and help team members understand procedures and performance standards.
- Collaborate with managers, case managers, clinical supervisors, account managers, and other personnel to resolve appeal questions.
- Respond to member, provider, and client inquiries about appeal status, processes, and outcomes.
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