Provides operational support for the intake, prioritization, and coordination of medical appeals to ensure timely and compliant processing. This role performs initial review of incoming appeals, differentiates between expedited and standard requests, and facilitates accurate routing to appropriate clinical staff. The position requires strong attention to detail, independent work capability, and adherence to HIPAA, regulatory, and accreditation standards.
Job Responsibilities
Accountabilities and Essential Functions
Reviews incoming appeal requests (mail, fax, electronic) to determine eligibility and classification
Differentiates between expedited and standard appeals to ensure compliance with regulatory timeframes
Establishes and maintains appeal cases within designated systems (e.g., EPIC)
Prioritizes, organizes, distributes, and tracks appeals to appropriate clinical staff
Coordinates workflow to ensure timely processing and adherence to service level expectations
Performs research and prepares documentation to support appeal processing
Assists Medical Appeals Specialists during periods of high volume or absence, including case setup, routing, and processing
Maintains accurate records and documentation in compliance with data retention and audit requirements
Ensures adherence to HIPAA, accreditation standards, and all applicable federal and state regulations
Collaborates with internal departments to support resolution and ensure compliance
Identifies process improvement opportunities and communicates recommendations to leadership
Performs additional duties as assigned within the scope of the role
Numbers & Facts
Location
Baton Rouge, LA
Job Type
Contractor
Salary
$18–$22 Per Hour
Company Size
201 - 500
Year Founded
1939
Qualifications
Work Experience
3 years of insurance experience, including benefits and claims research (required) 2 years of experience in customer service and/or claims processing (required) Experience may run concurrently Experience with Facets application (preferred)