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Appeals Coordinator

Lumeris -
Remote

Apply Now

Job Details

Full-time
$39,000 - $48,150 a year
4 days ago

Benefits

Health savings account
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Employee discount
Life insurance

Qualifications

Research
High school diploma or GED

Full Job Description

Your Future is our Future

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

We're excited to consider every qualified candidate authorized to work in the United States, although we are unable to sponsor visas for this role at this time.

Position:

Appeals Coordinator

Position Summary:

Responsible for reviewing, researching, and resolving appeals. Escalates complex appeals as needed. Ensures compliance with all applicable regulations, standards, timelines, policies, and guidelines.

Job Description:

Primary Responsibilities

Reviews, evaluates, documents, and tracks appeal documents. Follows request through resolution by established processes and procedures, and within established time standards.
Creates, composes, and provides quality written responses (applying the appropriate composition, grammar, punctuation, and spelling) to appeals request within established time standards.
Helps identify areas of improvement for self and the department.
Prepares case files for Independent Review Entities or other levels of the Appeals process.
Communicates with members and providers on appeal resolution.
Performs peer QA of appeal notification letters.
Ensures compliance with all state and federal regulations (Center for Medicare and Medicaid Services, National Committee for Quality Assurance) and guidelines with day to day activities.

Qualifications

High School or equivalent
1 + years Appeals related experience or the knowledge, skill, abilities to succeed in the role
Strong learning agility and enthusiastic about developing new skills
Ability to interact professionally and maintain confidentiality and high ethical standards
Ability to multi-task, meet deadlines, and adapt to changing priorities
Solid oral and written communication skills
Good computer skills, specifically with Microsoft Word, Excel, PowerPoint, and Outlook
Solid attention to detail

Working Conditions

While performing the duties of this job, the employee works in normal office working conditions
Work weekends and company holidays as needed based on business regulatory requirements

#LI-Remote

Pay Transparency:

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.

The hiring range for this position is:

$39,000.00-$48,150.00

Benefits of working at Lumeris

Medical, Vision and Dental Plans
Tax-Advantage Savings Accounts (FSA & HSA)
Life Insurance and Disability Insurance
Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
Employee Assistance Program
401k with company match
Employee Resource Groups
Employee Discount Program
Learning and Development Opportunities
And much more...

Be part of a team that is changing healthcare!

Member Facing Position:

No- Not Member or Patient Facing Position

Location:

Remote, USA

Time Type:

Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.

Disclaimer:

The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.

Apply Now

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Position:

Position Summary:

Job Description:

Pay Transparency:

Member Facing Position:

Location:

Time Type:

Disclaimer:

Lumeris is an EEO/AA employer M/F/V/D.

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