Sentara
Provider Appeals Coordinator/CPC/CCS- Remote in Virginia or Florida!
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Job Description
- Req#: JR-87716
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Remote work flexibility available for candidates in Virginia and Florida
- Comprehensive benefits package including medical, dental, vision plans, and more
- Annual discretionary bonus opportunity based on eligibility criteria
- Tuition assistance up to $5,250/year and student debt pay down program of $10,000
- Supportive and inclusive workplace culture that values diversity
What to Expect (Job Responsibilities):
- Investigate and document member appeals and grievances in compliance with state laws and regulations
- Collaborate with the Plan's Medical Directors on clinical appeals and the Appeals Manager on non-clinical appeals
- Maintain accurate records and documentation related to appeals and grievances
- Ensure timely response to member inquiries regarding their appeals
- Assist in the development and implementation of appeals processes and protocols
What is Required (Qualifications):
- High School Diploma or equivalent is required
- Certified Professional Coder (CPC) and Certified Coding Specialist (CCS) certifications from AHIMA are required
- Minimum of 3 years of experience in managed care is required
- Previous experience with provider appeals is a plus
- Strong knowledge of healthcare regulations and compliance standards
How to Stand Out (Preferred Qualifications):
- Experience in a healthcare environment focusing on appeals and grievances
- Familiarity with various healthcare plans and services
- Strong analytical and problem-solving skills
- Excellent written and verbal communication abilities
- Ability to work effectively in a fast-paced and dynamic environment
#HealthcareServices #AppealsCoordinator #RemoteWork #CareerGrowth #InclusiveWorkplaceAbout the company
Join a national healthcare leader dedicated to growth, innovation and patient safety. Join Sentara.
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