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Appeals Coordinator

Southwest Service Administrators

This is a Full-time position in Phoenix, AZ posted March 26, 2021.

The Appeals Coordinator is responsible for providing expertise in reviewing, researching, investigating, negotiating, and resolving both verbal & written appeals and grievances from members and providers within stringent time frames.

We pride ourselves on being flexible, but there are some things we feel very strongly about:Being an excellent communicator, because you take care in articulating your own thought process, as well as critique the work of others.Understanding the whole business. Great systems aren’t built in a vacuum – they require hard work from extremely smart people across many disciplines and an understanding of how it all fits together.Great teams are better than the all-star players. No matter how great someone’s ideas, they’ll be improved upon through collaboration.

ResponsibilitiesAppeals and Grievances

  • Gain and maintain the understanding of the plan designs and effectively apply that knowledge.
  • Maintain a comprehensive working knowledge of Policies, Procedures, Compliance Regulations, Schedule of Benefits and turnaround times across all product lines.
  • Maintain an understanding of claims processing and an ability to research claims issues.
  • Prepare acknowledgment and response letters to members and providers.
  • Maintain case records on all complaints, grievances, and appeals.
  • Identify, research and resolve claim disputes received from a variety of sources.
  • Ability to multitask on multiple appeals simultaneously, prioritizing work and completing within stringent time frames.
  • Prepare statistical analysis for required reporting.
  • Analyze and track trends.

Teamwork

  • Work cooperatively with other team members
  • Actively participate in team meetings and training activities.
  • Perform additional responsibilities and projects as periodically assigned.

Education/Certification:

  • High School Diploma/GED
  • Minimum of five (5) years of experience with coding certification

Skills/Abilities:

  • Prior grievance and appeals experience preferred.
  • Extensive knowledge of medical terminology, CPT Codes, ICD 9/10 and medical claim forms.
  • Strong analytical and research skills with the ability to read and assess medical documentation and draw valid conclusions.
  • Proficiency in interpretation of plan documents.
  • Solid knowledge of MS Excel & MS Word.
  • Minimum 40 WPM and 3,000 KPH proficiency
  • Strong mathematical skills required
  • Professional, client-focused approach to colleagues and assignments.
  • Strong oral and written communication skills with exceptional attention to details.
  • Ability to seek out experiences that may change perspective or provide an opportunity to learn new things.
  • Strong dedication to follow-through on all tasks and assignments.
  • Ability to organize, set priorities, work independently and complete multiple projects within established deadlines.
  • Ability to sit for long periods of time operating a computer keyboard.
  • Bi-lingual in English and Spanish a plus.

Competencies:Analytical, Problem Solving, Critical Thinking, Communications, Interpersonal Relations/Teamwork, Organization Awareness, Self/Life Management, Continuous Improvement/Innovation and Change, Basic Technical Competence

Employee Benefits Program

  • One of the most competitive Paid Time Off plans in the industry.
  • Extensive 401(k) plan with company matching for contributions up to five percent of an employee’s base pay.
  • Affordable medical, dental and vision insurance; along with company paid disability and life insurance.
  • Family and employee care programs.

Apply Today

Skills Required

  • Medical Billing & Coding
  • claims

Package

Salary: $16.00-$18.87

Apply at www.ssatpa.com