Appeals Coordinator

Overview

Appeals Coordinator Jobs in New York City, New York, USA at Vanguard Temporaries, Inc.

Responsibilities

   

   Review and maintain daily mail, faxes and emails received by the Appeals Department to ensure information is accurate and saved electronically, updating memos, and maintaining various weekly/monthly logs, including but not limited to cumulative mail and call volume logs.

   Assist supervisor with appeals and other claim inquiries.

   Access QNXT (medical/hospital claims system, provider and V3 (Vi-Tech) to verify member’s eligibility, demographics, provider records, and claims images.

   Generate, track, and send letters via email and fax to members and providers.

   Maintain accurate data entry of receipt of appeals and inquiries in claims processing system (QNXT) & V3.

   Track and ensure completeness of daily provider inquires; ensure they are sent to appropriate payment area for benefit reconsideration.

   Inbound and Outbound

communication

with members, providers, etc., verbally and in writing, via Appeals Hotline, faxes and/or email.

   Provide clerical support to the Appeals Department, including but not limited to. handling of mail. filing, typing, photocopying, faxing, deliveries, etc.

   Retrieve messages from Appeals Hotline, to include callbacks, and maintain log report.

   Index and archive documents/files electronically in DMS.

   Perform additional duties and projects as assigned by management.

   

   Qualifications

   

   High School Diploma or GED required

   Minimum two (2) year clerical experience in a general office environment required

   Knowledge of QNXT claims and provider system with the ability to effectively and efficiently check medical and hospital claims history, eligibility and provider participation record

   Accurate data entry skills required

   Basic skill level in Microsoft Word and Excel preferred

   Basic knowledge of web-based applications

   Excellent oral and written

communication skills

   Ability to read, comprehend instructions, correspondence, and memos

   Detail-oriented, ability to work under pressure; ability to follow-up and handle multiple tasks

   Good

attention to detail

and organizational skills

   Ability to work independently and as a team

   Ability to handle and lift light to moderately heavy boxes (up to 40 lbs.) as needed

   Must be able to maintain the confidentiality required of the organization and the department

   Must meet performance standards including attendance and punctuality

Title: Appeals Coordinator

Company: Vanguard Temporaries, Inc.

Location: New York City, New York, USA

Category: Administrative/Clerical (Healthcare Administration), Healthcare (Healthcare Administration)