Job Description

Stefanini Group is hiring! Stefanini is looking for Appeals Intake Coordinator-Remote 100% For quick apply, please contact Rahul Kumar; Ph: 248 936 5060 [email protected] W2 Candidates Only! Job Summary: The Appeals intake coordinator position is focused on the processing of incoming member and provider Medicare appeals and grievances. This team member will screen incoming complaints and appeals for level of urgency, benefit or medical necessity issues and other appropriate inquiries. This team member will assign the incoming concern to the appropriate analyst and may assist in investigations, documentation gathering, and correspondence as needed. This team member may also participate in auditing and monitoring activities as assigned. This team member will promote quality member care and customer service/satisfaction. This team member will interact with Customer Service, Utilization Management, Medical Directors, and other internal teams as necessary to effectively triage incoming complaints and appeals. Essential Functions: Review and triage incoming Medicare appeals and grievances based on urgency and type of concern. Assign incoming complaints, appeals, and inquiries to the appropriate analyst for review and resolution. Assist with investigations, documentation collection, and correspondence related to appeals and grievances. Correspond with members, providers, and regulatory agencies regarding decisions and actions. Collaborate with Customer Service, Utilization Management, Medical Directors, and other internal teams to effectively manage incoming concerns. Participate in auditing and monitoring activities as assigned. Communicate, collaborate, and cooperate with internal and external stakeholders. Promote quality member care and customer service satisfaction. Adhere to all compliance requirements and HIPAA regulations. Support departmental goals that contribute to the overall success of the organization. Qualifications: Education: High School Diploma or equivalent required. Experience: Minimum of one (1) year of health insurance or managed care experience performing Appeals and Grievances functions. Knowledge, Skills, and Abilities: Knowledge of healthcare delivery systems. Ability to work in a fast-paced environment with changing priorities. Strong collaboration and teamwork skills. Effective written communication skills. Strong time management and prioritization skills. Demonstrated problem-solving abilities. Strong organizational skills and attention to detail. Ability to identify and define problems, gather and analyze information, establish facts, draw valid conclusions, and implement changes related to federal regulations. Technical Skills: Proficiency with Microsoft Office applications. Experience with Health Edge, Epic, and/or Facets preferred. Stefanini takes pride in hiring top talent and developing relationships with our future employees. Our talent acquisition teams will never make an offer of employment without having a phone conversation with you. Those face-to-face conversations will involve a description of the job for which you have applied. We also speak with you about the process including interviews and job offers. About Stefanini Group: The Stefanini Group is a global provider of offshore, onshore and near shore outsourcing, IT digital consulting, systems integration, application, and strategic staffing services to Fortune 1000 enterprises around the world. Our presence is in countries like the Americas, Europe, Africa, and Asia, and more than four hundred clients across a broad spectrum of markets, including financial services, manufacturing, telecommunications, chemical services, technology, public sector, and utilities. Stefanini is a CMM level 5, IT consulting company with a global presence. We are CMM Level 5 company