Appeals Coordinator

Northwest Physicians Network - Tacoma, WA

Full-time
Save

Appeals Coordinator

Northwest Physicians Network is now offering qualified candidates an opportunity to join our team as an Appeals Coordinator. Our company values innovative problem solvers promotes personal and professional growth and provides a supportive working environment that affords all team members a healthy work/life balance.

The Appeals Coordinator is responsible for the management of all appeal requests received from the health plans. The Coordinator will complete the full process of thoroughly investigating and bringing to full completion with applicable regulations and standards. The Coordinator will analyze the appeal request, coordinate the decision-making process, and generate a response within the established timelines.

Northwest Physicians Network creates the opportunity for independent private practitioners to thrive in Washington State. By providing clinical integration support and data driven quality improvement, we have created a high value delivery network, making it possible for our providers to remain focused squarely on their patients. We are proud of the accomplishments and the advances we have made for our patients, patients and our community.

Status: Regular, Full-time, FLSA Non-exempt

Base Rate (negotiable d.o.e.) + Competitive Benefits

Primary responsibilities will include:

  • Maintains a caseload and monitors day to day compliance of appeal decision time frames for claims and clinical appeal requests.
  • Reviews appeal request and determines administrative, claims or clinical appeal.
  • Enters all data related to appeals and case reviews into a database.
  • Prepares and sends all required documentation for appeals to the requesting health plan.
  • Participates in data gathering and analysis of reports regarding appeal activity as well as preparing for appeals audits, monitors QI (Quality Improvement) activities of appeals department, and assists in the development of department work flows and implementations.
  • Consults with managers on problem cases and interfaces with case managers, clinical supervisors, claims managers and other personnel in resolving denial and appeal questions.
  • Responds health plan telephone inquiries regarding status, process and outcome of appeals.
  • Organizes volume of work and work-flow so that performance standards and proper procedures for appeals resolution according to client requirements and state and federal regulations are addressed.
  • Experience in customer interactions and detailed review of health-related materials.
  • Strong interpersonal skills and attention to detail.
  • Ability to organize work and seek help on tasks where needed.
  • Strong writing and proofing skills required ensuring documents meet standards and are accurate.

Minimum Requirements:

Education: Associates Degree in Business Administration or Healthcare related field, preferred

Experience:

  • 3 years administrative experience with increasing level of responsibility
  • 2 years working experience, within the last 5 years, with managed care products, Federal and State regulatory requirements (i.e., NCQA, HCFA, DOC), multiple health care delivery systems preferred

What's the first thing that happens when one of the leading independent medical groups in the country comes together with a global leader in health care? Opportunity. With DaVita Medical Group, HealthCare Partners, The Everett Clinic, Northwest Physicians Network, MountainView Medical Group and Magan Medical Clinic joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. We're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(SM)

Careers with OptumCare. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. OptumCare, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)

Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Type: Full-time

Experience:

  • relevant: 3 years (Preferred)

Work Location:

  • One location

Benefits:

  • Health insurance
  • Dental insurance
  • Vision insurance
  • Retirement plan
  • Paid time off
  • Flexible schedule
  • Parental leave
  • Professional development assistance
  • Tuition reimbursement

Schedule:

  • Monday to Friday
  • No weekends