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Appeals Clerk in Irving, TX at Pionear

Date Posted: 5/24/2019

Job Snapshot

  • Employee Type:
  • Location:
    Irving, TX
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Job Description:

  • Handles written response to all incoming correspondence, appeals and complaints, from members and outside agencies. Creates weekly statistical reports and prepares Appeal Hearings folders.
  • Generates, processes, tracks and stores all requested correspondence (electronic and hard copy) related to appeal hearings. Sorts and files all generated correspondence.
  • Triages and prepares per SOP appeal folders for review by Grievance and Appeals staff. 
  • Properly logs and tracks each appeal by type (provider or member).
  • Triages and directs all incoming faxes through (Right Fax System or G&A database). Assists clinical staff with outbound faxing to providers/ODJFS. Performs data entry of member demographic and provider information updates.
  • Prepares, files and stores hard copy folders that contain denial information. Responds to and completes requests for correspondence as appropriate.
  • Sorts, stamps, counts and batches all incoming mail (including member correspondence, enrollments, etc.).
  • May sort and distribute all incoming and interoffice/departmental mail and post outgoing U.S. mail and all certified and Express mail.

Job Requirements

Experience Required:

  • Experience: 0-2+ years experience working in a Medicaid managed care environment that included contact with medical providers, vendor and clients (members). 
  • 6 months experience working with databases such as Excel and/or Access. 0-2+ years experience in business writing.
  • Working knowledge Microsoft Office or other comparable software
  • Excellent analytical skills Demonstrated adaptability and flexibility to changes and response to new ideas and approaches
  • Demonstrated problem solving and time management skills
  • Demonstrated ability to meet established deadlines Excellent organizational, verbal and written communication skills
  • Ability to abide by policies Ability to maintain attendance to support required quality and quantity of work
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Education: 

  • High School Diploma or equivalent GED Required