Medicare Appeals Intake Coordinator

Centene Corporation

3d•$19 - $33

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Shifts will be Monday - Friday working 8am - 5pm CST. Position Purpose: Responsible for ensuring proper appeal classification, and identification of valid appeals, through intake and triage of member and provider appeal cases efficiently, and in compliance with regulatory requirements. This role requires strong attention to detail, organizational skills, and the ability to coordinate with multiple teams to ensure timely resolution of appeals. Maintain comprehensive knowledge of all products. Receive, review, and log appeal requests in the applicable appeal system. Responsible for initial data entry function of appeals activity into applicable appeals systems. In accordance with both company policy and governmental regulations, triage appeal requests to determine appropriate area for resolution. Appropriately identify urgent cases and process expeditiously to ensure timely routing to other areas. Maintains accurate records, and ensures compliance with CMS (Centers for Medicare & Medicaid Services) regulations. Generate member and provider written communications when required. Ensure appropriate case classification is entered for all cases reviewed. Ensure confidentiality and security of sensitive information. Actively participate in meetings. Assist with special projects and perform other duties as necessary. Performs other duties as assigned. Complies with all policies and standards.

Requirements

High School Diploma or equivalent required.
1+ years Managed Care Organization, health insurance, physician's office, hospital, or Medicare Advantage operations (i.e. claims, call center, mailroom) required.

Nice To Haves

Experience in Medicare appeals, or related field preferred.
Experience in handling requests related to dual-eligible members preferred.
Familiarity with Medicare regulations and CMS guidelines with basic knowledge and understanding of the process for enrollees that have both Medicare and Medicaid benefits preferred.

Responsibilities

Receive, review, and log appeal requests in the applicable appeal system.
Responsible for initial data entry function of appeals activity into applicable appeals systems.
In accordance with both company policy and governmental regulations, triage appeal requests to determine appropriate area for resolution.
Appropriately identify urgent cases and process expeditiously to ensure timely routing to other areas.
Maintains accurate records, and ensures compliance with CMS (Centers for Medicare & Medicaid Services) regulations.
Generate member and provider written communications when required.
Ensure appropriate case classification is entered for all cases reviewed.
Ensure confidentiality and security of sensitive information.
Actively participate in meetings.
Assist with special projects and perform other duties as necessary.
Performs other duties as assigned.
Complies with all policies and standards.