Analysis Skills, Communication Skills, Customer Relations, Data Entry, Demographics, Detail Oriented, Fax Machines, HIPAA (Health Insurance Portability and Accountability Act), Healthcare, Microsoft Office, Organizational Skills, Presentation/Verbal Skills, Problem Solving Skills, Standard Operating Procedures (SOP), Statistical Reports, Time Management, Writing Skills
Appeals Clerk
Job Title: Appeals Clerk
Duration: 3+ months contract
Location: Milwaukee, Wisconsin 53224
Shift: 8:00AM to 5:00PM
Job Description
Need strong data entry abilities, healthcare experience and attention to details. Will take information and transfer appeals documentation over to proprietary system and use data entry skills to enter additional appeals information into the appeals database. Summary: Handles written response to all incoming correspondence, appeals and complaints, from members and outside agencies. Creates weekly statistical reports and prepares Appeal Hearings folders.
Essential Functions:
- Generates, processes, tracks and stores all requested correspondence (electronic and hard copy) related to appeal hearings.
- Sorts and files all generated correspondence.
- Triages and prepares per SOP appeal folders for review by Grievance and Appeals staff.
- Properly logs and tracks each appeal by type (provider or member).
- Triages and directs all incoming faxes through (Right Fax System or G&A database).
- Assists clinical staff with outbound faxing to providers/ODJFS.
- Performs data entry of member demographic and provider information updates.
- Prepares, files and stores hard copy folders that contain denial information.
- Responds to and completes requests for correspondence as appropriate.
- Sorts, stamps, counts and batches all incoming mail (including member correspondence, enrollments, etc.).
- May sort and distribute all incoming and interoffice/departmental mail and post outgoing U.S. mail and all certified and Express mail.
Knowledge/Skills/Abilities:
- Working knowledge Microsoft Office or other comparable software
- Excellent analytical skills
- Demonstrated adaptability and flexibility to changes and response to new ideas and approaches
- Demonstrated problem solving and time management skills
- Demonstrated ability to meet established deadlines
- Excellent organizational, verbal and written communication skills
- Ability to abide by policies
- Ability to maintain attendance to support required quality and quantity of work
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
Additional Information
All your information will be kept confidential according to EEO guidelines.
C
Careers Integrated Resources