Appeals Clerk

Reference Code: 4718

Position Title: Appeals Clerk
Location: Long Beach, CA 90802
Duration: 3 months contract with possible extension

Notes:

• 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

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.