Appeals Coordinator

Job description

Job DetailsJob Location: Phoenix, AZ - Phoenix, AZ 85027Position Type: Full-TimeThe Appeals Coordinator is responsible for providing expertise in reviewing, researching, investigating, negotiating, and resolving both verbal & written appeals and grievances from members and providers within stringent time frames. Responsibilities: Appeals and Grievances: Gain and maintain the understanding of the plan designs and effectively apply that knowledge. Maintain a comprehensive working knowledge of Policies, Procedures, Compliance Regulations, Schedule of Benefits and turnaround times across all product lines. Maintain an understanding of claims processing and an ability to research claims issues. Prepare acknowledgment and response letters to members and providers. Maintain case records on all complaints, grievances, and appeals. Identify, research and resolve claim disputes received from a variety of sources. Ability to multitask on multiple appeals simultaneously, prioritizing work and completing within stringent time frames. Prepare statistical analysis for required reporting. Analyze and track trends. Teamwork: Work cooperatively with other team members Actively participate in team me...