Sentara Healthcare
Provider Appeals Coordinator/CPC/CCS- Remote in Virginia or Florida!
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Job Description
- Req#: JR-87716
Employer Industry: Health Insurance
Why consider this job opportunity:
- Full-time, permanent position with standard working hours from 8 AM to 5 PM EST, Monday to Friday
- Opportunity for career advancement and growth within a family-friendly culture
- Comprehensive benefits package including medical, dental, and vision plans
- Adoption, fertility, and surrogacy reimbursement up to $10,000
- Potential for annual discretionary bonuses based on employee eligibility
- Remote work opportunity available in Virginia and Florida
What to Expect (Job Responsibilities):
- Investigate and document member appeals and grievances in compliance with state laws and regulations
- Collaborate with Medical Directors regarding clinical appeals and grievances
- Work with the Appeals Manager on non-clinical appeals and grievances
- Ensure thorough documentation and adherence to provider and group agreements
- Support members with chronic illnesses through custom wellness programs
What is Required (Qualifications):
- High School Diploma or equivalent required
- Certified Professional Coder (CPC) and Certified Coding Specialist (CCS) certifications from AHIMA
- Minimum of 3 years experience in managed care
- Previous experience with provider appeals preferred
How to Stand Out (Preferred Qualifications):
- Experience in handling provider appeals
- Familiarity with healthcare regulations and compliance standards
- Strong analytical and problem-solving skills
- Excellent communication skills to interact with various stakeholders
#HealthInsurance #RemoteWork #CareerGrowth #HealthcareJobs #ManagedCare
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Sentara Healthcare is a not-for-profit healthcare organization serving Virginia and northeastern North Carolina.
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