Appeals Clerk

 In

Website Administrative

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.

 

 

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