Appeals Support Specialist

Job description

Eviden is an Atos Group business with an annual revenue of circa € 5 billion and a global leader in data-driven, trusted and sustainable digital transformation. As a next generation digital business with worldwide leading positions in digital, cloud, data, advanced computing and security, it brings deep expertise for all industries in more than 47 countries. By uniting unique high-end technologies across the full digital continuum with 55,000 world-class talents, Eviden expands the possibilities of data and technology, now and for generations to come.

 

Shift Schedule: Nightshift 

Work Setup: Hybrid 

 

Summary: 

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The Appeals Coordinator is responsible for the timely and accurate triaging all appeals, grievances, and complaints that come into the department, and working with the providers and members to get necessary information to process their requests within regulatory guidelines. The Appeals Coordinator is also responsible for daily/weekly/monthly department reporting, and cross coverage when necessary. 

Qualifications and Experience:      

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Must be a graduate of bachelor’s degree. 

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A minimum of two (2) years administrative assistant experience or comparable experience required. 

Duties and Responsibilities:     

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Act as the first line of defense for all appeals, grievances and complaints that come into the department. Review the information received to ensure completeness, and follow up with outside departments, members, and providers as necessary to get the information required. 

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Review quality of care complaints, determine what the provider needs to respond to, and work with the provider to get a response within regulatory turnaround times.  

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Complete all supporting tasks necessary for regular reports so all recipients receive the information in an accurate and timely manner. 

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Assist the Manager, Appeals and Ambulatory Review with special projects and initiatives, as needed  

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Understand the daily operations of the Department to answer both internal and external customers’ questions as they relate to the initiatives set by management. 

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Coordinate the arrangement of meetings as they apply to the Department’s needs.  Participate in the meetings by taking minutes or notes as requested by management and complete meeting minutes within the established guidelines. 

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Coordinate the arrangement of committee meetings and all materials required prior to and after the meeting, as well as completing the meeting minutes/notes.  

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Maintain internal and regulatory turnaround time requirements for mailings, scanning, correspondence & inbox standards. 

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Maintain a high degree of confidentiality with regards to member/provider specific data 

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Adapt to changing work priorities and a fast-paced environment while maintaining a professional attitude 

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The employee agrees to comply with CDPHP’s Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the Corporate Compliance Policy and has a duty and obligation to report any suspected violations of any law, the standards of conduct or Corporate Compliance Policy to his or her immediate Supervisor, the fraud and abuse hotline, the Compliance Officer, the Compliance Director, Human Capital Management or the Chief Executive Officer. 

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Performs other duties as assigned. 

Skills & Abilities:     

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Experience with Microsoft Office Word required.  

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Ability to type 45 wpm with 90% accuracy required. 

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Demonstrated ability to produce business correspondence and written documents which exhibit appropriate grammar, spelling, punctuation, and sentence structure.

Let’s grow together.