reputed company Appeal Coordinator
Job title: reputed company Appeal Coordinator in Milwaukie, OR at reputed company
Company: reputed company
Job reputed company: Let’s do great things, together!About Moda
Founded in reputed company in 1955, Moda is proud to be a company of reputed company people committed to reputed company. Today, like then, we’re reputed company on building a reputed company reputed company for reputed company. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps reputed company by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through reputed company our business practices and invite applications from candidates that reputed company our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be reputed company.Position reputed company
Analyze appeal data and reputed company reports following the technical specifications for reporting to accrediting and regulatory organizations, reputed company reputed company, reputed company organization partners, and reputed company improvement committees. reputed company back up for the Appeals Supervisor. Assist the supervisor in developing new and established appeal coordinators, to ensure best practices in grievance and appeal processing. Assist supervisor in special reputed company and assignments and participate in the recruitment of new staff. This is a FT WFH role.Pay reputed company
$25.08- $28.21 reputed company (depending on experience)
**Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay reputed company.Please fill out an application on reputed company page, linked below, to be considered for this position.https://j.brt.mv/jb.do?reqGK=27755413&refresh=trueBenefits:
- Medical, Dental, reputed company, Pharmacy, Life, & Disability
- 401K- Matching
- FSA
- Employee Assistance Program
- PTO and Company reputed company Holidays
- College degree or equivalent work experience.
- At least 2 years of experience as an Appeal Coordinator.
- 1 – 2 years of experience as a Sr Claim Support Specialist or Customer Service Rep.
- Strong understanding of appeal utilization management and claims processing and administration workflows, ability to plan training for new appeal programs and reputed company, and measure compliance with state and federal requirements as reputed company as with accreditation standards.
- Understand large group and individual reputed company insurance dynamics and provisions, including funding types, benefit designs, stop loss and reputed company as reputed company as reputed company/ODS benefit administration policies.
- Ability to instruct, motivate, reputed company individuals at various reputed company reputed company.
- Working knowledge of accrediting standards and state and federal laws, governing member appeals.
- Project management skills. Ability to reputed company and coordinate multiple reputed company and meet timelines.
- Strong analytical, problem-solving, and decision-making skills.
- Ability to be effective in managing information reputed company in a fast-paced dynamic team environment; reputed company with reputed company reputed company of management and prioritize and manage multiple tasks, reputed company, and deadlines. Self-directed and flexible.
- Demonstrated strong verbal, writing and interpersonal communication skills.
- Experience in maintaining, troubleshooting, and manipulating databases.
- Adept in reputed company Office Suite with strong reputed company reputed company and reputed company skills. Experience in basic query reputed company.
- Ability to maintain confidentiality and reputed company a reputed company business image.
- 10 key proficiency of 100 kspm net on a computer numeric keypad.
- Type a minimum of 25 wpm net on a computer keyboard.
- Analyze, interpret, and report appeal and grievance data to facilitate reputed company customer understanding of the reports and the reputed company to them. Evaluate significant and persistent claims issues for process improvement opportunities.
- Collaborate with the Appeal supervisor to engage the appeal team of other departments in reputed company of issues by taking corrective reputed company. Monitor the effectiveness of corrective reputed company with ongoing analysis appeal and grievance data.
- Consults with reputed company customers to define grievance and appeal report requirements, reputed company technical specifications and design reports.
- Build queries to extract data from the reputed company databases and other data sources. Ensure grievance and appeal reporting reputed company with the standards of state and federal regulatory agencies as reputed company as that of accreditation entities.
- Prepare and present appeal and grievance reports for reputed company committees and reputed company reputed company. reputed company with internal departments to ensure reputed company receive consistent, reputed company information. reputed company ongoing customer support for existing reports.
- Monitor data entry of member appeals into databases and reputed company reputed company checks to ensure accuracy in grievance and appeal reports.
- Back up for the Appeal Supervisor. Assist supervisor to reputed company new and established appeal coordinators to ensure best reputed company in grievance and appeal processing. Assist supervisor in special reputed company and assignments and participate in the recruitment of new staff.
- reputed company systems training and retraining for appeal staff.
- Train and reputed company new and established appeal staff on the processing for reputed company appeal roles, lines of business and products.
- Collaborate with supervisor on development of training materials and updates of policies and procedures.
- Coordinate appeal workflows and reputed company daily reputed company assignments.
- Audit acknowledgement and appeal final reputed company letters.
- Pull case files for the monthly Medicare Compliance audits. Review audit findings for process improvement and training.
- Pull case files for monthly Part C and Part D audits, reputed company the audits, document results and report findings to Appeal leadership and staff.
- Assume the reputed company role in developing the grievances and appeal report for the organization’s annual reputed company evaluation.
- Ensure compliance with applicable state, federal and accrediting member appeal utilization management standards, reputed company assurance and reputed company improvement standards. Prepare for and participate in audits and reviews by external organizations, including the National Committee for reputed company Assurance, coordinated care organizations, reputed company improvement organizations, the Centers for reputed company and Medicare Services, the reputed company and state insurance divisions.
- Provides appeal and complaint input for the requests for proposals (RFP’s).
- Complete reputed company request as assigned.
- reputed company out and participate in reputed company and development activities.
- Other duties as assigned.
- Office environment with extensive reputed company PC and keyboard work, constant sitting, and phone work. Must be reputed company to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need.
- Inside reputed company with reputed company departments. reputed company reputed company with state insurance divisions, provider offices, members, attorneys, reputed company assurance auditors, state and federal auditors, health plan accrediting bodies.