Sentara
Provider Appeals Coordinator/CPC/CCS- Remote in Virginia or Florida!
7 days agoWhat's your preference?
Job Description
- Req#: JR-87716
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely from Virginia or Florida
- Comprehensive benefits package, including medical, dental, and vision plans
- Annual discretionary bonus eligibility based on established criteria
- Tuition assistance of up to $5,250/year and student debt pay-down up to $10,000
- Supportive and family-friendly workplace culture
What to Expect (Job Responsibilities):
- Investigate and document member appeals and grievances in compliance with state laws and regulations
- Collaborate closely with the Plan's Medical Directors on clinical appeals and grievances
- Work with the Appeals Manager on non-clinical appeals and grievances
- Ensure adherence to provider and group agreements during the appeals process
- Maintain accurate records and documentation related to appeals and grievances
What is Required (Qualifications):
- High School Diploma or equivalent
- Certified Professional Coder (CPC) and Certified Coding Specialist (CCS) certifications from AHIMA
- Minimum of 3 years of experience in Managed Care
- Previous provider appeals experience is preferred
How to Stand Out (Preferred Qualifications):
- Experience with provider appeals processes
- Familiarity with healthcare regulations and compliance standards
- Strong analytical and problem-solving skills
- Excellent communication and interpersonal abilities
#HealthcareServices #RemoteWork #CareerGrowth #EmployeeBenefits #ManagedCare
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