Physical Health Coordinator (Appeals Non-Clinical)

Job Title: Physical Health Coordinator

Contract Duration: 6 months, possible extension

Work Arrangement: Remote

Pay: $20

Summary Under supervision, this position is responsible for providing support to members, clinicians, and physicians in the processing of Physical Health clinical appeals, including responding to inquiries, conducting outbound calls, conducting research, performing data entry, resolving problems by working across departments, and supporting the Physical Health Appeals Department.

A secondary description notes responsibility for supporting Physical Health clinical appeals through responding to inquiries, conducting outbound calls, conducting research, performing data entry, volume management, productivity tracking, resolving problems across departments, and supporting the Physical Health Appeals Department. Required weekend and holiday rotation.

Responsibilities Member, Provider & Clinician Support

• Receive and respond to customer, clinician, or physician inquiries.
• Process information from members or providers to determine needs/wants and ensure customer/clinician/physician questions have been addressed.
• Respond or send inquiries to the appropriate internal party.
• Receive and respond to customer, clinician, or physician inquiries to support the Physical Health Appeals Department.

Appeals Processing & Case Support

• Distribute Physical Health appeals to Appeals clinicians based on assigned parameters.
• Provide support to the clinical team by performing the non-clinical functions necessary to generate and close a case within the platform.
• Responsible for scrubbing appeals in the MedHoK Appeals Application.
• Research the next level of appeal and communicate information to the member, provider, and facility when applicable.
• Responsible for uploading clinical data to any external review organization if needed.

Administrative & Operational Support

• Conduct outbound calls.
• Conduct research.
• Perform data entry.
• Maintain production requirements based on established department business needs.
• Assign and delegate work items received via email and/or medical management system.
• Support volume management and productivity tracking.
• Resolve problems by working across departments.

Compliance & Professional Conduct

• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company business.
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

Education & Experience

• 1 or 2 years of college OR
• 3 years of experience with automated systems.

Required Skills & Qualifications

• Knowledge of medical terminology.
• Database experience or PC applications experience.
• Experience coordinating member needs.
• Experience providing assistance to members.
• Experience analyzing member needs.
• Customer service skills.
• Verbal and written communication skills.
• Interpersonal skills to assist members and coordinate care with physician offices.
• Ability to develop written correspondence to members and other department personnel.
• Ability to support departmental personnel and functions.

Work Environment

• Fully remote.
• Monday-Friday schedule.
• 40 hours per week.
• Mandatory holiday rotation (3-4 assigned holidays per year).
• Mandatory weekend rotation (one weekend every 3rd weekend).
• Required weekend and holiday rotation.