Appeals Coordinator

Posted 9 days ago

integrated resourcesSan Diego (CA)

Administrative Law Judges, Adjudicators, and Hearing Officers Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

SENIORITY

Senior

Apply

About the role

Appeals Coordinator Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

Job Description: Job Title: Appeals Coordinator

Duration: 6 + months contract to hire position.

Location: San Diego CA 92108 Requirements/

Certifications: HS/GED.1-2 years of appeals/claims/scheduling or coordination experience (a plus if all 3).Managed Care experience is a PLUS.

Schedule: Monday-Friday 8:30AM - 5:00PM PST.6 month contract with possibility of conversion depending upon performance.

Job Summary: Responsible for processing and recording appeals and/or provider disputes as well as coordinating scheduling with internal and external PA reviewers for determinations and appeals. Provides high level of accuracy and quality in produced materials and interactions with members and providers.

Essential Functions: Maintain a caseload of appeals, non-authorizations, provider disputes and/or PA review scheduling as assigned- Process appeals, non-authorizations and provider disputes according to policies, work flows Document process and findings within database Contact and respond to members and providers within required timeframes as required by contracts, regulations and standards. Prepare written materials following policies and procedures for notification and tracking purposes of appeals, provider disputes and PA review scheduling. Identify risk areas and reports such to unit manager Consult with manager on problem cases and interfaces with unit staff in data obtainment and resolution. Prepare and present information on non-authorizations, appeals and provider disputes to external review organizations and customers. Assist in data gathering and reporting of non-authorizations, appeals and provider disputes. Contribute to CMC/Client's office and department CQI processes by participating in unit goal setting, scorecard development and departmental meetings.

Additional Information: All your information will be kept confidential according to EEO guidelines.

Before you apply

Applying takes about a minute. These four things decide how fast it moves after that.

Your profile is current

It's what we read first. Occupations, seniority and locations matter more than a long history.

Two examples you can talk through

Not a portfolio — just two pieces of work where you can explain the decisions and what you'd change.

A number in mind

What you're on now and what would make you move. We negotiate better when we know both.

Your notice period

Employers plan around it, and it's the question that stalls offers most often.

Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.