Appeals Coordinator

Job description

ESSENTIAL DUTIES AND RESPONSIBILITIES: - Create patient specific appeal letters by incorporating the reason of medical necessity for why the denial should be overturned. - Coordinate prescriber review and signature of completed letters. - Prepare and submit appeal documentation to insurance companies. - Communicate with patients, healthcare providers, and insurance companies to gather necessary information. - Work closely with provider office point of contact(s) to obtain updated information in order to create appeals, draft letters, as well as follow pharmacy workflow steps to provide a streamlined appeal process for offices and payers. - Maintain accurate and up-to-date records of all appeals processed - Process fax queues, emails, answer incoming calls and adhere to all thresholds for authorization management. - Monitor appeal deadlines and ensure timely submission of all required documents. - Input accurate and clear data entry of call logs, important case notes and authorization details into CRM system. - Collaborate with internal departments to ensure comprehensive appeal support. - Research and stay current with changes in healthcare policies and regulations. - Provide statu...