Appeals Coordinator - Remote (Ak, Az, Fl, Id, Or, & Wa)

Job Title
Appeals Coordinator - Remote (AK, AZ, FL, ID, OR, & WA)
Duration
Open Until Filled
Work From Home
Yes
Description
Let’s do great things, togetherFounded in Oregon in 1955, ODS, now Moda, is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.Investigate and respond to medical, pharmacy and dental grievances, complaints, appeals, and inquiries for the organization.
Respond to outside regulatory inquiries as needed.This Work From Home PST position is open to candidates living or willing to relocate to the following States; AK, AZ, FL, ID, OR, or WA. Follow the link below and complete an application for this position.
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https://j.brt.mv/jb.do?reqGK=27708807&refresh=true
Benefits

• Employee Assistance Program
• Medical, Dental, Vision, Pharmacy, Life, & Disability
• FSA
• PTO and Company Paid Holidays
• 401K- Matching

Schedule

• PST

Requirements

• Demonstrated proficiency in computer applications such as Word, Excel, or other core operating systems.
• Demonstrated knowledge of CMS rules for Medicare and Medicaid grievance, complaint and appeal processes preferred.
• Ability to adhere to Moda Health attendance policies and work assigned schedule which may include some overtime and occasional weekend and Holiday coverage.
• 10 key proficiency of 105 kspm on a numeric keypad.
• High School diploma or equivalent.
• Knowledge and understanding of complaint and appeal procedures preferred.
• Demonstrated initiative, analytical, problem solving, and organizational skills.
• Ability to communicate positively, patiently, and courteously.
• Demonstrated strong reading, verbal, written and interpersonal communication skills.
• 6 months to 2 years of experience of medical/dental claims processor or customer service preferred.
• Ability to maintain confidentiality and project a professional business image.
• Ability to interpret benefit contracts and/or Moda Health administrative policies, products, and business lines.
• Ability to work well under pressure and meet deadlines while completing a high volume of work.
• Type a minimum of 25 wpm accurately on a computer keyboard.

Primary Functions

• Ability to maintain a full caseload.
• Other duties as assigned
• Meets the departments established production and accuracy standards for case completion.
• Handbooks) and determine actions required.
• Respond to independent review entity requests for member case files within the stipulated timelines and ensure appropriate documentation required for reporting. Staff may also be required to respond to DFR requests or attend Medicaid hearings as a representative of the company.
• Research all grievances, complaints, correspondence, and appeals. Perform a complete review at each stage of the complaint/appeal process and ensure the appropriate documentation, including claim review to determine over/underpayment.
• Accurately document in system the outcome of grievances, complaints, and appeals.
• Interpret contracts (evidence of coverage
• Work with appropriate departments to effectuate decisions.
• Communicate effectively and appropriately with other departments to ensure complete and fair reviews of grievances, complaints, and appeals.
• Communicate by letter and/or telephone with members, claimants, independent review entities, attorneys, and providers regarding claims/policies on Moda Health benefit plans.
• Respond in writing (or orally when appropriate) to requests, grievances, complaints, and appeals within the mandated timeframes.

Together, we can be more. We can be better. Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our [email protected] email.
Pay Range
¤20.07
Hourly to ¤23.03
Hourly