Appeals Associate
Where
- Bedford, TX
What you'll be doing
- Responsible for handling member and provider appeals/complaints involving medical necessity, retroactive authorizations, prescription drug coverage, and/or member eligibility. Responsible for tracking and reporting performance against HHSC guidelines. May complete intake, initialize the case for processing, and ensure cases are completed in a quality, organized, and timely fashion. Principle accountabilities: Responsible for intake of appeals/complaint unit mail, sorting, and distributing within required timeframes. Responsible for date stamping and properly identifying request type and region. Utilizes appropriate system to research required documentation for case work up. Contacts parties to obtain missing/outstanding information for processing and completion. Obtains waivers of liability (WOL), authorization of representative (AOR), and medical records requests.
What your background should be
- Understanding of claims, membership, state contracts, and health services systems. Good organizational skills. Excellent verbal and written communication skills. Detail oriented. Ability to meet deadlines and multi-task as well as performing effectively in an environment with frequent workload changes and competing demands. Strong sense of customer service. Preferred requirements : Knowledge of appeals and complaint process. Prior experience in managed care appeals, claims, or health services environment.
Required Schooling / Training
- High school diploma or equivalent
Who is the client company
- This is a global health services organization that provides medical, dental, disability, life and accident insurance and related products and services.
- If you are interested in this position, send your resume to apply@kochdavis.com
