Provider Appeals Coordinator
Job Description
Provider Appeals Coordinator
Location: Birmingham, AL
Work Schedule: Hybrid schedule with regular onsite presence at the VIVA HEALTH corporate office and some work-from-home opportunities.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
- Comprehensive Health, Vision, and Dental Coverage
- 401(k) Savings Plan with company match and immediate vesting
- Paid Time Off (PTO)
- 9 Paid Holidays annually plus a Floating Holiday to use as you choose
- Tuition Assistance
- Flexible Spending Accounts
- Healthcare Reimbursement Account
- Paid Parental Leave
- Community Service Time Off
- Life Insurance and Disability Coverage
- Employee Wellness Program
- Training and Development Programs to develop new skills and reach career goals
- Employee Assistance Program
See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits
Job Description
The Provider Appeals Coordinator is responsible for processing written provider appeals for participating VIVA HEALTH and VIVA Medicare Plus providers as well as non-participating providers for commercial plan members. This position assists with and participates in meetings of the Provider Appeals Committee. This position is responsible for documenting the end-results of the appeals process.
Key Responsibilities
- Review written appeals upon receipt. Forward non-par Medicare appeals to the Medicare Member Appeals and Grievances department.
- Research provider appeals and present findings in a concise manner to the Provider Appeals Committee.
- Effectuate the Committee’s decisions with regard to claims reprocessing or provider outreach.
- Maintain an accurate log of all incoming provider appeals and work efficiently to close cases accurately and within required time frames.
REQUIRED:
- High School Diploma or GED
- 1+ years’ experience working for a managed care company/health plan in customer service, claims, or appeals
- Excellent written and oral communication skills are essential
- Proficient in standard office software (Excel, Word, Access)
- Ability to perform tasks with little supervision
- Basic computer skills
PREFERRED:
- Some college
- 1+ years’ experience with DST system
- Experience in the managed healthcare industry
- Advanced computer skills
