Appeals Associate

Appeals associate will be responsible for coordinating and monitoring the administrative and non-clinical services
for the clinical appeals team. These duties include, but are not limited to, setting up work assignment schedules,
investigating, analyzing, providing statistical reports and reporting patterns as applicable to the clinical appeals
department. He/ She provide these services in an efficient manner ensuring that denial process is up to date.

-Print Medical records- Admission notes, Progress notes, Nurse progress notes, Medical order, Lab results (15 to 20 cases per day) pertaining to Appeals and mail them out to the corresponding Payor along with Appeal and the Cover Letter. 

-Update the appeal status report on a daily basis. Monitors and follows-up with the clinical information being presented to Managed Care Organizations. Follow up on the Appeal determination (Appealed cases without determination after 60 days) - Call the Insurance Payors (5
cases)- ask for determination and update care manager and appeal status report.

-Sort cases based on time frame and notify to clinical team on a weekly basis. Receive Payor communications from the clinical team- via Email and update the care manager and appeal status report.

-Retrieves Payor communication from the lock box. Sends Initial adverse determinations to PFS team for denial creation, Print attaches and updates the care manger with the appeal determinations. 

-Assists the Director with the scheduling and conducting of monthly meetings with the staff of clinical appeals. Confers with the Director and/or designee in the evaluation of review activity. Makes recommendations regarding improvement of same.Operates standard office equipment ,Performs other duties as assigned.

-Assumes special projects as deemed appropriate by the Director and/or designee of clinical appeals department.

- Bachelors degree required.

-Experience in health care environment preferred.
-Experience in Electronic medical records and processing environment preferred.
-Experience in Excel spread sheets, Microsoft word required.
-Strong communication skills both verbal and written required.
-Ability to multitask and willingness to learn new skills.