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Company name : EVERSANA-US
Location : St. Louis, MO
Position : Appeals Resource Coordinator
Description :
THE POSITION: The Appeals Resource Coordinator is responsible for providing oversight and facilitation of the Medical Necessity Appeals workflow. This position provides administrative, organizational and clerical support to the Medical Necessity Appeals Team. The Appeals Resource Coordinator will work in collaboration with patients/families, Patient Service Coordinators, Clinical Appeals Nurses, insurance companies, and client representatives to ensure Medical Necessity Appeals needs are met to the highest level of quality and efficiency.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by:
Facilitate the patient consented Medical Necessity Appeals process.
Identify and report issues that require additional investigation, validate discrepancies, and ensure appropriate follow up.
Assist in the coordination, submission and updates of patient consented medical necessity appeals.
Collaborate with the Medical Necessity Appeals team to resolve any appeals related issues.
All other duties as assigned
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
EXPECTATIONS OF THE JOB:
Review cases assigned to appeals for completeness and assign to Clinical Appeals Nurse as appropriate
Monitor Fed-ex delivery of appeals to insurance companies and follow up to ensure timely processing
Provide client feedback as requested on appeals processing timelines.
The above list reflects the general details necessary to describe the expectations of the position and shall not be construed as the only expectations that may be assigned for the position.
An individual in this position must be able to perform the expectations listed above successfully.
MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES:
The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required.
High School Diploma or GED
1 year of administrative experience, preferably in an insurance setting
Excellent verbal, written, and proofreading skillsAbility to prioritize and manage multiple tasks
Self-directed; reliable; detail oriented
Working knowledge of Microsoft Word, Excel and Outlook
Superior customer service and typing skills
PREFERRED QUALIFICATIONS:
Reimbursement and Pharmacy experience
PHYSICAL/MENTAL DEMANDS AND WORKING ENVIRONMENT:
The physical and mental requirements, along with the work environment characteristics described here, are representative of those an individual encounters while performing the essential functions of this position.
Office: While performing the essential functions of this job the employee is frequently required to reach, grasp, stand and/or sit for long periods of time (up to 90% of the shift), walk, talk and hear; occasionally required to lift and/or move up to 25 pounds. The noise level in the work environment is usually moderately quiet, with frequent interruptions and multiple demands.
Job Type: Full-time
Pay: $20.00 per hour
Benefits:
401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance
Schedule:
8 hour shift
Day shift
Monday to Friday
Experience:
Case management: 1 year (Preferred)
Customer service: 1 year (Preferred)
pharmacy benefit management: 1 year (Preferred)
Shift availability:
Day Shift (Required)
Work Location: Remote
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