SrAdmin-Appeals

Essential Duties and Responsibilities:

• Work with sensitive information & maintain confidentiality - PHI/PII.
• Create decision letters for clinical reviews.
• Perform QC of completed reviews and decision letters.
• Adjudication support to clinical team and management.
• Perform triage for new appeals.
• Prepare and Fax requests for information and/or documentation, as needed.
• Perform data entry accurately in systems.
• Perform work on special projects, as needed.
• Assist/support other projects, as determined by management.
• Work independently in remote setting.
• Complete assigned work according to deadlines.
• Meet or exceed productivity metrics.
• Maintain quality score of 95% or above.
• Able to function in fast-paced environment.
• Participate in team meetings.
• Work schedule flexibility, as determined by management team.
• Perform other duties assigned by management.

Minimum Requirements:

• High School diploma, GED, or equivalent required.
• Associate’s degree, preferred.
• 2-4 years of experience required.
• Computer skills – MS Office Suite, MS Outlook, MS Teams.
• Strong written and verbal communication skills.