Appeals Coordinator - Medicaid

Location
Virginia Beach, VA
Posted
Aug 31, 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 is hiring an Appeals Coordinator
to join our team in Virginia Beach, VA.

Hours/Shift: 8-5p

Monday - Friday, Day shift, 40 hours/wk.

Department/Position Overview:

We are seeking an experienced, professional Appeals Coordinator to help support our Optima leadership and our efforts to fulfill our mission on a daily basis. Professional, well-balanced, self-directing yet a collaborative team player with an unsurpassed administrative talent and keen sense of proactivity to drive a positive work environment are ideal. Additional key qualities include but are not limited to: multitasking, attention to detail, effective communication, and strong organizational skills to maintain multiple calendars from multiple leaders. Ability to sit for long periods of time performing job functions and strong Microsoft Office experience is a must.

Required experience: Managed Care - 3 years

Division Highlights:

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.

As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission “to improve health everyday.” This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support -every day. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.


Sentara Benefits:

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, and growth!

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