APPEALS COORDINATOR

6 days left

Location
Virginia Beach, VA
Posted
Sep 07, 2017
Closes
Sep 30, 2017
Function
Nurse
Industry
Healthcare
Hours
Full Time
Job Description:

Optima Health is seeking a detail-oriented and analytical professional to join our Business and System Integration team in the role of an Appeals Coordinator. In this unique appeals role, the selected candidate will work with the Federally Facilitated Marketplace to research, resolve and respond to Individual Product member appeals. This is a full-time, non-remote position located in our operations facility in Virginia Beach, VA..

Responsible for the investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements. Works closely with the Plan's Medical Directors who are responsible for all decision regarding clinical appeals/ grievances and the Appeals Manager who is responsible for non-clinical appeals and grievances.

Education Level
High School Grad or Equivalent

Experience
Required: Managed Care - 3 years

Preferred: None, unless noted in the “Other” section below

License
None, unless noted in the “Other” section below

Skills
Required: Microsoft Access, Microsoft Excel, Microsoft Word

Preferred: None, unless noted in the “Other” section below

Other
Provider Appeal Coordinator positions require CPC Certification within 1 year of eligibility.