[Hiring] Appeals Coordinator @Lucet

Role Description

The Appeals Coordinator processes and documents all aspects of appeal cases including:

• Receipt date and time of an appeal
• Full investigation of the substance of the appeal and any records, written comments or information pertaining to the appeal

This position requires understanding standards set forth by:

• National Committee for Quality Assurance (NCQA)
• Utilization Review Accreditation Commission (URAC)
• Department of Labor (DOL)
• Centers for Medicare and Medicaid Services (CMS)
• Federal and State laws

The Appeals Coordinator is accountable for understanding Member and Provider Rights and Responsibilities and structure surrounding claims and appeals. Responsibilities include:

• Assisting the Appeals Specialists with the day-to-day operations of the Appeals Department

Qualifications

• Associates degree and 1+ year of relevant healthcare experience
• Equivalent combination of education and relevant healthcare appeals, claims, utilization management, or health plan experience may be considered in lieu of a degree including high school diploma with 3+ years’ of relevant healthcare experience
• 1+ years of healthcare appeals, claims, utilization management or related health plan experience
• Proficient in Microsoft Office (Word, Excel, Outlook, etc.) and appeals documentation system
• Demonstrated knowledge of applicable federal and state regulations, accreditation standards, privacy, confidentiality, and security requirements related to healthcare information
• Ability to pass background check upon hire and throughout employment

Requirements

• Demonstrated flexibility and adaptability to changing processes and various software programs
• Ability to manage multiple priorities in a fast-paced environment
• Professional demeanor and ability to work collaboratively with multiple levels of professionals and line staff
• Excellent problem-solving, organizational and attention to detail skills

Benefits

• Hourly compensation between $22.15 to $24, PLUS an annual performance-based, discretionary incentive
• Comprehensive health benefit options: Medical, dental, and vision coverage
• 401(k) with competitive employer match
• Company-paid life and disability insurance
• Paid parental leave and wellbeing incentives
• Generous paid time off, including volunteer time
• Flexible spending accounts for healthcare and dependent care
• Professional development opportunities and tuition reimbursement
• Remote work flexibility (role-dependent)
• Opportunity for meaningful growth, both personally and professionally