Clinical Appeals Coordinator

Job Description

The Appeals Coordinator is responsible for gathering all information required on an appeal, writing, and submitting the appeal to insurance company and for all follow up phone calls and documentation of these appeals.

Responsibilities

Confirm prescriber/ patient request to appeal.

Verify the information needed by the plan for an appeal and where to submit.

Gather all necessary information from prescriber office to complete the appeal.

• Responsible for writing the letter of appeal.

Notifying appropriate staff of approved/denied medications.

Process/reverse online claims as required.

Responsible for maintaining required spreadsheets if applicable.

Responsible for all follow up phone calls to the insurance company or prescriber office for status of appeal or request for additional information.

Responsible for all documentation of appeal statuses into CPR+ progress notes.

Update sales staff with pertinent information.

Participate and perform other duties as assigned by leadership.

Skills & Abilities

Demonstrate the Bio Plus C.A.R.T. values.

Competence

Accountability

Respect

Trust

Knowledge of medical terminology.

Ability to work cooperatively and be a liaison between departments when needed.

Professional Image.

QUALIFICATIONS & ABILITIES:

High School Diploma or Equivalent.

At least 1 year experience working with appeals, prior authorizations, or billing.

Specialty pharmacy experience preferred.

Bio Plus offers competitive compensation packages including health care, 401(k), growth potential, and a challenging and exciting work environment.

Bio Plus is an Equal Opportunity Employer.