[Hiring] Appeals Intake Coordinator @Stefanini Group

Role Description

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.
• Assign the incoming concern to the appropriate analyst.
• Assist in investigations, documentation gathering, and correspondence as needed.
• Participate in auditing and monitoring activities as assigned.
• Promote quality member care and customer service/satisfaction.
• Interact with Customer Service, Utilization Management, Medical Directors, and other internal teams as necessary to effectively triage incoming complaints and appeals.

Qualifications

• High School Diploma or equivalent required.
• Minimum of one (1) year of health insurance or managed care experience performing Appeals and Grievances functions.
• 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.
• Proficiency with Microsoft Office applications.
• Experience with Health Edge, Epic, and/or Facets preferred.

Requirements

• Adhere to all compliance requirements and HIPAA regulations.
• Support departmental goals that contribute to the overall success of the organization.

Company Description

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.