Appeals Coordinator

I ntegrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

JOB Title:
Appeals Coordinator

Duration: 6+ months contract to hire position

Location:
San Diego, CA 92108

• 1-2 years of appeals/claims/scheduling or coordination experience (a plus if all
  3)
• Managed Care experience is a PLUS
• 6-month contract with possibility of conversion depending upon performance

Responsible for processing and recording appeals and/or provider disputes, as well as coordinating scheduling with internal and external PA reviewers for determinations and appeals. Provides a high level of accuracy and quality in produced materials and interactions with members and providers.

• Maintain a caseload of appeals, non-authorizations, provider disputes, and/or PA review scheduling as assigned. Process appeals, non-authorizations, and provider disputes according to policies and workflows.
• Document process and findings within database.
• Contact and respond to members and providers within required time frames as mandated by contracts, regulations, and standards.
• Prepare written materials following policies and procedures for notification and tracking of appeals, provider disputes, and PA review scheduling.
• Identify risk areas and report them to the unit manager.
• Consult with the manager on problem cases and interface with unit staff for data obtainment and resolution.
• Prepare and present information on non-authorizations, appeals, and provider disputes to external review organizations and customers.
• Assist in data gathering and reporting of non-authorizations, appeals, and provider disputes.
• Participate in CQI processes by contributing to goal setting, scorecard development, and departmental meetings.

All your information will be kept confidential according to EEO guidelines.