1 Appeal Coordinator Job in Roanoke, VA

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Appeal Coordinator

Delta Dental of Virginia

Roanoke, VA | Full Time

$40k-49k (estimate)

0 Months Ago

Appeal Coordinator

$40k-49k (estimate)

Full Time 0 Months Ago

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Delta Dental of Virginia is Hiring an Appeal Coordinator Near Roanoke, VA

Position Summary:

The Appeal Coordinator oversees the appeal workflow, ensuring quality and timeliness of appeal responses, recommending changes to operational policies and procedures, and producing monthly/quarterly internal and external appeal reports as requested.

Coordinates the daily workflow to proceed with the appeal process that has been initiated by a provider or subscriber regarding a denied/disallowed claim. Responsible for requesting and assembling all necessary documentation and history regarding the appeal. Responsible for logging, tacking and monitoring the appeal status in order to guarantee the process is completed within the determined timeline. Appeal Coordinator will work closely with the Appeal Auditor to ensure that the appeal process meets all protocol and deadlines.

Essential Functions:

Maintain and modify appeal letter templates as necessary
Provide monthly appeal reports to Dental Director for senior DDVA staff, Corvesta Services, and/or external clients
Recommends and manages improvements to automate processes, improve customer satisfaction and decrease costs
Manages Quality of Care (QOC) and billing complaints receipt to resolution within specified time restraints
Research and gather all necessary clinical documentation for consultant review
If needed a request will be made by letter or email to obtain additional information required to complete review of appeal/correction
Group Specific Ad-hoc reports
Performs other duties as assigned

Qualifications/Education/Experience:

Must have excellent written and verbal communication skills
Must have strong time management skills, strong interpersonal skills, and ability to work independently and productively with minimal supervision
Requires four years of dental or health care experience
Prefer customer service, eligibility and enrollment, grievance and appeals or project management experience, but not required, dependent upon capabilities noted in resume
High School diploma or GED equivalent
Strong interpersonal and communication skills

Physical Demands and Work Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical demands: While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. Use of hands is required for such technological devices such as a computer, telephone, and others. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. The employee will be required to travel (sometimes long distances) to attend required meetings.
Work environment: The work is limited to the office environment with occasional trips to other office facilities or locations necessitating walking outdoors or driving. The noise level in the work environment is usually minimal.