Job Description
Lead Appeal Coordinator I
Job Title
Lead Appeal Coordinator I
Duration
Open Until Filled
Work From Home
Yes
Work Remote
Yes
Description
Let’s do great things, together
Founded in Oregon in 1955, ODS, now Moda, is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.
Analyze appeal data and ensure compliance of the technical specifications for reporting to accrediting and regulatory organizations, client groups, healthcare organization partners, and quality improvement committees. Provide back up for the Appeals Supervisor. Assist the supervisor in developing new and established appeal coordinators, to ensure best practices in grievance and appeal processing. Assist supervisor in special projects and assignments and participate in the recruitment of new staff.
This is a full-time remote position.
Follow the link below and complete an application for this position.
https://j.brt.mv/jb.do?reqGK=27717790&refresh=true
Benefits:
- Medical, Dental, Vision, Pharmacy, Life, & Disability
- 401K- Matching
- FSA
- Employee Assistance Program
- PTO and Company Paid Holidays
Schedule:
- PST
Requirements:
- College degree or equivalent work experience.
- At least 2 years of experience as an Appeal Coordinator.
- 1 – 2 years of experience as a Sr Claim Support Specialist or Customer Service Rep.
- Strong understanding of appeal utilization management and claims processing and administration workflows, ability to plan training for new appeal programs and projects, and measure compliance with state and federal requirements as well as with accreditation standards.
- Understand large group and individual healthcare insurance dynamics and provisions, including funding types, benefit designs, stop loss and underwriting as well as Moda Health/ODS benefit administration policies.
- Ability to instruct, motivate, direct individuals at various skill levels.
- Working knowledge of accrediting standards and state and federal laws, governing member appeals.
- Project management skills. Ability to track and coordinate multiple projects and meet timelines.
- Strong analytical, problem-solving, and decision-making skills.
- Ability to be effective in managing information flow in a fast-paced dynamic team environment; interact with all levels of management and prioritize and manage multiple tasks, projects, and deadlines. Self-directed and flexible.
- Demonstrated strong verbal, writing and interpersonal communication skills.
- Experience in maintaining, troubleshooting, and manipulating databases.
- Adept in Microsoft Office Suite with strong Microsoft Excel and Access skills. Experience in basic query methods.
- Ability to maintain confidentiality and projects a professional business image.
- 10 key proficiency of 100 kspm net on a computer numeric keypad.
- Type a minimum of 25 wpm net on a computer keyboard.