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Appeals Clerk

Company: The Wherry Group LLC
Location: Long Beach
Posted on: March 19, 2023

Job Description:

Job Description: - The position will require onsite responsibilities immediately via a rotating schedule to perform scanning and mail functions. - Must have requirements: Customer service, claims experience or Appeals and Grievances Case intake for Health Plan is preferred. - Day to day responsibilities: Responsible for reviewing incoming and outgoing mail, completing intake of all incoming appeals and grievances (faxes, mail, system), data entry into our A&G tracking system, identifying requests that require rerouting and redirect appropriately. - Shift is 8am - 5pm PST Summary: Handles written response to all incoming correspondence, appeals and complaints, from members and outside agencies. Creates weekly statistical reports and prepares Appeal Hearings folders. Essential Functions: 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. Knowledge/Skills/Abilities: 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 Molinas 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 Experience: 0-2+ years experience working in a Medicare 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. Comments for Suppliers:

Keywords: The Wherry Group LLC, Long Beach , Appeals Clerk, Other , Long Beach, California

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