Efficiently and accurately conducts the intake of appeals and related requests resulting from scanned mail, customer service calls and faxes. Determines appropriate classification of each request, performs accurate data entry and conducts initial processing and assignment of appeals requests.
- Conducts intake and appropriate classification of appeals requests and makes accurate judgment on appeal, grievance, claim dispute or other issue and follows procedures on how to handle each type of request.
- Utilizes multiple systems to gather information, conduct research, assess the situation, and enter data. Needs to access and interpret claim and authorization data.
- Completes initial data entry of all appeal requests in an environment where compliance and accuracy are critical.
- Ensures expedited requests are escalated and processed immediately.
- Redirects records as needed and follows up with manager as needed to determine appropriate action steps.
- When necessary, creates and runs basic reports and queries to produce useable data and distributes as needed.
- Develops and presents ideas for performance and process management improvement within the department
- Performs special duties as assigned.
Education: High School Diploma
Experience: 1 years practical work experience in a claims, customer service, or data entry position; preferably in a health services environment
Special Skills (e.g. 2nd language):
Ability to review correspondence and system data to determine appropriate handling consistent with applicable P&P
Good verbal and written communication skills
Good interpersonal skills required to work well with others
Ability to work across multiple computer programs to process a single request
Proficient in data entry
Knowledge of Microsoft Office Products including Outlook, Word and Excel.