Description:
It's a great time to put the strength of Coventry Health Care behind your career! Coventry is currently recruiting for projected openings in our Coventry Health Care of Kansas health plan related to our anticipated entrance into the Government health insurance exchange program. Start dates will be in the fall, once participation in the exchanges is approved by the Government.
Coventry Health Care provides a full range of risk and fee-based managed care products and services to a broad cross section of employer and government-funded groups, government agencies, and other insurance carriers and administrators.
GENERAL SUMMARY
The Appeals Coordinator is responsible for coordinating appeals activities and ensuring compliance with state and federal regulations and accrediting bodies.
ESSENTIAL RESPONSIBILITIES
- Responsible for collecting, organizing, and tracking information to facilitate and expedite member appeals.
- Reviews appeal to determine what additional documentation is needed to make an appropriate decision. Contacts providers to request information or more detailed explanation of services rendered. Researches administrative or non-clinical aspects of the appeal.
- Researches member information in response to difficult inquiries, including, but not limited to, authorizations, payments, denials, coordination of benefits. Resolves difficult issues to achieve member satisfaction.
- Prepares files for review by the health plan Medical Director and/or Appeals Committee.
- Ensures all timeframes are met throughout the grievance process.
- Works closely with medical management staff to obtain clinical information for appeals related to the denial of services.
- May develop monthly appeals reports including but not limited to the number of appeals by category, the number of denials upheld, and confirmation that timeframes were met.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent experience.
- Previous (1-2 years) experience in customer service and/or claims processing required.
- Previous experience processing and working with all types of insurance products including HMO, PPO, and Indemnity under both fully insured and self-funded arrangements.
- Knowledge of medical terminology required.Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Administrative Support Workers
Primary Location: Overland Prk, KS, US
Other Locations: Wichita-Kansas-United States,
Organization: 13000 - CHC of Kansas
Schedule: Full-time
Job Posting: 2013-08-19 00:00:00.0
Job ID: 1312642
It's a great time to put the strength of Coventry Health Care behind your career! Coventry is currently recruiting for projected openings in our Coventry Health Care of Kansas health plan related to our anticipated entrance into the Government health insurance exchange program. Start dates will be in the fall, once participation in the exchanges is approved by the Government.
Coventry Health Care provides a full range of risk and fee-based managed care products and services to a broad cross section of employer and government-funded groups, government agencies, and other insurance carriers and administrators.
GENERAL SUMMARY
The Appeals Coordinator is responsible for coordinating appeals activities and ensuring compliance with state and federal regulations and accrediting bodies.
ESSENTIAL RESPONSIBILITIES
- Responsible for collecting, organizing, and tracking information to facilitate and expedite member appeals.
- Reviews appeal to determine what additional documentation is needed to make an appropriate decision. Contacts providers to request information or more detailed explanation of services rendered. Researches administrative or non-clinical aspects of the appeal.
- Researches member information in response to difficult inquiries, including, but not limited to, authorizations, payments, denials, coordination of benefits. Resolves difficult issues to achieve member satisfaction.
- Prepares files for review by the health plan Medical Director and/or Appeals Committee.
- Ensures all timeframes are met throughout the grievance process.
- Works closely with medical management staff to obtain clinical information for appeals related to the denial of services.
- May develop monthly appeals reports including but not limited to the number of appeals by category, the number of denials upheld, and confirmation that timeframes were met.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent experience.
- Previous (1-2 years) experience in customer service and/or claims processing required.
- Previous experience processing and working with all types of insurance products including HMO, PPO, and Indemnity under both fully insured and self-funded arrangements.
- Knowledge of medical terminology required.Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Administrative Support Workers
Primary Location: Overland Prk, KS, US
Other Locations: Wichita-Kansas-United States,
Organization: 13000 - CHC of Kansas
Schedule: Full-time
Job Posting: 2013-08-19 00:00:00.0
Job ID: 1312642