Appeals Clerk


Website Administrative

Reference Code: 4975

Position Title: Appeals Clerk, 16629-1
Location: Irving TX 75038
Duration: 3 months contract with possible extension

Comments for Suppliers:    
– 100% onsite position
– Work shift: 8am – 5pm CST
– Day to day responsibilities: mail processing, data entry, claims review, uploading cases into database application, email correspondence , general office capabilities
– Must have requirements: Data entry experience, basic Microsoft Suite experience, experience scanning documents
– Seeking candidates with a background in claims or appeals processing. Not a requirement but highly desired.

Summary: Handles written response to all incoming correspondence, appeals and complaints, from members and outside agencies. Creates weekly statistical reports and prepares Appeal Hearings folders.

Essential Functions: Generates, processes, tracks and stores all requested correspondence (electronic and hard copy) related to appeal hearings. Sorts and files all generated correspondence. Triages and prepares per SOP appeal folders for review by Grievance and Appeals staff. Properly logs and tracks each appeal by type (provider or member). Triages and directs all incoming faxes through (Right Fax System or G&A database). Assists clinical staff with outbound faxing to providers/ODJFS. Performs data entry of member demographic and provider information updates. Prepares, files and stores hard copy folders that contain denial information. Responds to and completes requests for correspondence as appropriate. Sorts, stamps, counts and batches all incoming mail (including member correspondence, enrollments, etc.). May sort and distribute all incoming and interoffice/departmental mail and post outgoing U.S. mail and all certified and Express mail.

Knowledge/Skills/Abilities: Working knowledge Microsoft Office or other comparable software Excellent analytical skills Demonstrated adaptability and flexibility to changes and response to new ideas and approaches Demonstrated problem solving and time management skills Demonstrated ability to meet established deadlines Excellent organizational, verbal and written communication skills Ability to abide by policies Ability to maintain attendance to support required quality and quantity of work Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers Required

Education: High School Diploma or equivalent GED Required

Experience: 0-2+ years experience working in a Medicaid managed care environment that included contact with medical providers, vendor and clients (members). 6 months experience working with databases such as Excel and/or Access. 0-2+ years experience in business writing.



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