Reference Code: 4718
Position Title: Appeals Clerk
Location: Long Beach, CA 90802
Duration: 3 months contract with possible extension
- The position will require onsite responsibilities immediately via a rotating schedule to perform scanning and mail functions.
- Must have requirements: Customer service, claims experience or Appeals and Grievances Case intake for Health Plan is preferred.
- Day to day responsibilities: Responsible for reviewing incoming and outgoing mail, completing intake of all incoming appeals and grievances (faxes, mail, system), data entry into our A&G tracking system, identifying requests that require rerouting and redirect appropriately.
- Shift is 8am – 5pm PST
- Handles written response to all incoming correspondence, appeals and complaints, from members and outside agencies.
- Creates weekly statistical reports and prepares Appeal Hearings folders.
- 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.
- 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
- 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.