Appeals Coordinator

2 weeks ago

Pittsford, New York, United States Integrated Resources Full time
Job Title: Appeals Coordinator

Integrated Resources is seeking a highly skilled Appeals Coordinator to join our team. As an Appeals Coordinator, you will play a critical role in ensuring that our clients receive fair and timely resolutions to their healthcare appeals.

Key Responsibilities:
  • Maintain up-to-date knowledge of project and corporate policies and procedures.
  • Function as a Subject Matter Expert in one or more process areas.
  • Analyze data submitted for Independent Medical Review.
  • Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs, and health plans to input necessary information into the system.
  • Respond to incoming calls from clients, health plans, providers, and enrollees regarding case status, questions about the program, and the appeals process.
Requirements:
  • Associate degree with 2+ years' experience.
Preferred Qualifications:
  • Experience in healthcare claims or claims adjudication in healthcare.
  • Strong analytical and critical thinking skills.
  • Excellent written and verbal communication abilities.
  • Ability to handle sensitive information with integrity and confidentiality.
Skills:
  • Excellent communication skills (both written and verbal).
  • Critical and analytical thinking.
  • Familiarity with healthcare finance and insurance practices.
  • Experience working with federal healthcare regulations.
  • Attention to detail.
  • Proficiency in operating across various platforms and displays.
  • Ability to work efficiently and independently.
  • Able to follow processes and procedures.