Medical Appeals Coordinators (Remote in Tri-State) #35328
Admin/Office
Philadelphia, PA Contract To Hire Oct 17, 2023
Contemporary Staffing Solutions is seeking a Medical Appeals Coordinator to join our client for a remote opportunity (must live in the Tri-State Area)! This Contract-to-Hire opportunity is offering $26.66 - $32/hour!

Job Description:
  • Conducts examinations of appeals and grievances submitted by Medicare Advantage members, adhering to established protocols and CMS regulations.
  • Tasked with compiling case files for both clinical and administrative evaluation.
  • Investigates the case history, encompassing the member's enrollment and eligibility status, benefit plan details, and the circumstances surrounding the denial of services or the rejection of claims.
  • Engages with members or their representatives through verbal and written channels in accordance with departmental policies and stipulated timeframes.
  • Records all interactions systematically in the department's designated systems.
  • Communicates professionally and effectively with internal and external contacts to align and investigate information relevant to the member's appeal.
  • Ensures that case file documents are appropriately organized, securely stored following unit guidelines, and submitted promptly for quality assurance purposes.
  • Arranges case files for external review in accordance with regulatory guidelines and undertakes additional tasks as assigned.

Requirements:
  • Ideal candidates should possess either an associate degree or at least three years of experience in customer service or handling complaints.
  • Proficiency in writing.
  • Familiarity with Medicare and Medicare Supplemental products is advantageous.
  • Furthermore, qualified candidates should demonstrate their capability to manage intricate member concerns, exceptional skills in writing, editing, and proofreading, and excellence in customer service, organization, verbal and written communication.
  • Competency in software applications such as Adobe, Word, and Excel is also preferred.

Contemporary Staffing Solutions (CSS) has been a leading provider of contract, temporary, temporary-hire & direct hire solutions. We began as a staffing agency and evolved to a national provider of workforce management solutions with a niche recruitment focus in Accounting & Finance, Call Center & Office, Human Resources, Sales & Marketing, & Information Technology. To learn more about CSS, visit our website: www.ContemporaryStaffing.com.