Provider Appeals Coordinator

Job Description

Job Description

Provider Appeals Coordinator

Location: Birmingham, AL

Work Schedule: Hybrid schedule with regular onsite presence at the VIVA HEALTH corporate office and some work-from-home opportunities.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health -

Job Description

The Provider Appeals Coordinator is responsible for processing written provider appeals for participating VIVA HEALTH and VIVA Medicare Plus providers as well as non-participating providers for commercial plan members. This position assists with and participates in meetings of the Provider Appeals Committee. This position is responsible for documenting the end-results of the appeals process.

Key Responsibilities

• Review written appeals upon receipt. Forward non-par Medicare appeals to the Medicare Member Appeals and Grievances department.
• Research provider appeals and present findings in a concise manner to the Provider Appeals Committee.
• Effectuate the Committee’s decisions with regard to claims reprocessing or provider outreach.
• Maintain an accurate log of all incoming provider appeals and work efficiently to close cases accurately and within required time frames.

REQUIRED:

• High School Diploma or GED
• 1+ years’ experience working for a managed care company/health plan in customer service, claims, or appeals
• Excellent written and oral communication skills are essential
• Proficient in standard office software (Excel, Word, Access)
• Ability to perform tasks with little supervision
• Basic computer skills

PREFERRED:

• Some college
• 1+ years’ experience with DST system
• Experience in the managed healthcare industry
• Advanced computer skills