Appeals Coordinator

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