Full-Time Appeals Support Representative

The Appeals Support Representative role directly supports the Clinical Appeals Specialist in the administrative functions of Denials and Appeals within the Utilization Review Team.

This is a full-time remote position that will work Monday through Friday, 8:00am-4:30pm EST or 8:30-5:00pm EST.

Responsibilities:

• Complete outbound calls to payers for status updates on retro authorization requests and appeal submissions.
• Interact with third party insurance representatives and utilize online sites to review retro authorization and appeal status.
• Track and confirm weekly status updates on all outstanding appeal cases until final resolution.
• Request, track, and receive payer correspondence regarding approvals and denials to include acknowledgment letters and determination letters.
• Organize and scan all payer determination letters in KIPU charting system and update the Clinical Appeals Specialist within 24 hours of receipt.
• Document final appeal outcomes as well as case details in KIPU chart system and appeal spreadsheet.
• Obtain patient and/or guardian signatures on required payer consent forms.
• Submit retro authorization requests, provide support for retro SCA projects, and follow up on retro auth submissions until final resolution.
• Identify problem cases and escalate issues to Clinical Appeals Specialist as appropriate.
• Attend and participate in all monthly UR Team meetings and all quarterly Denials meetings.
• Adhere to privacy and HIPAA guidelines.
• Perform and/or assist with special projects as assigned.

Qualifications:

• Associate's degree required or High School Diploma plus 5-7 years of appeals and grievance experience; Bachelor's degree preferred.
• Ability to work Monday through Friday, 8:00am-4:30pm or 8:30am-5:00pm EST.
• Ability to utilize and navigate Zoom and Microsoft Teams for remote meetings and IM chat.
• Strong Microsoft Office skills (Excel, Word, Outlook)
• Experience with insurance follow up and/or appeals and grievances required.
• Familiarity with medical billing, provider relations, and/or healthcare office experience required.

Ideal Candidate Profile:

• Self-starter with strong attention to detail
• Ability to multi-task, high level of organization, and excellent communication skills
• Ability to remain flexible and adapt to changing situations
• Excellent customer service skills and strong analytical skills

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