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Senior Appeals Coordinator

ICONMA

This is a Full-time position in Los Angeles, CA posted January 14, 2022.

· The candidate must perform research and analysis of appeals filed by members, customers, and government entities to administer timely resolution within state and federal guidelines, benefit plan guidelines, and company policies and procedures.

· The candidate must maintain a caseload of appeals and performs assigned duties.

· The candidate must analyze and render final decisions of non-clinical appeals according to procedure, state and federal guidelines, benefit plan guidelines, company internal policies and work flows.

· The candidate must coordinate the appeal and dispute process through the collection of clinical records and consultation with Physician Advisors/Medical Director and communicates final determination.

Job Requirements:

Requirements

·            The candidate must be familiar with and can assist in coordinating peer review scheduling involving internal Physician Advisors and external vendors.

·            The candidate must have 2+ years’ experience in processing appeals and/or claims.

·            The candidate must have 2+ years Behavioral Health, Healthcare or Managed Care Industry experience.

·            The candidate must have experience working in a contact center environment

 

As an equal opportunity employer, ICONMA prides itself on creating an employment environment that supports and encourages the abilities of all persons regardless of race, color, gender, age, sexual orientation, citizenship, or disability.