APPEALS COORDINATOR

Location
Virginia Beach, VA
Posted
Sep 05, 2018
Closes
Sep 27, 2018
Function
Nurse
Industry
Healthcare
Hours
Full Time
Job Description: 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.

Optima Health, Virginia Beach, has an opening for an Appeals Coordinator. This position is full time, day shift.

3 years Managed Care experience required.

Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.

Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!


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