[Hiring] Appeals Intake Coordinator @Sunrise Systems

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.

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

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

• Fax processing.
• Learning new processes.
• Manual intake work.
• Strong attention to detail.

Benefits

• Sunrise offers ACA compliant medical coverage, dental insurance, and vision insurance to all employees.
• We also offer sick time benefits as required per State regulations.

Contact

Jaya Balaji: [email protected] | (732) 515-5373 | URL: www.sunrisesys.com