Appeals Coordinator
MC-Rx, Gainesville, GA, United States
Essential Duties And Responsibilities
Create patient specific appeal letters by incorporating the reason of medical necessity for why the denial should be overturned.
Coordinate prescriber review and signature of completed letters.
Prepare and submit appeal documentation to insurance companies.
Communicate with patients, healthcare providers, and insurance companies to gather necessary information.
Work closely with provider office point of contact(s) to obtain updated information in order to create appeals, draft letters, as well as follow pharmacy workflow steps to provide a streamlined appeal process for offices and payers.
Maintain accurate and up-to-date records of all appeals processed.
Process fax queues, emails, answer incoming calls and adhere to all thresholds for authorization management.
Monitor appeal deadlines and ensure timely submission of all required documents.
Input accurate and clear data entry of call logs, important case notes and authorization details into CRM system.
Collaborate with internal departments to ensure comprehensive appeal support.
Research and stay current with changes in healthcare policies and regulations.
Provide status updates and resolution outcomes to involved parties.
Develop and implement strategies to improve the appeals process.
Assist in training new staff members on the appeals process.
Verify the accuracy and quality of data entry within authorizations prior to submission.
Safeguard, protect, and properly handle protected health information in accordance with all HIPAA laws and company policies/procedures.
Assess, prioritize and resolve client issues using good listening and comprehension skills.
Work cooperatively and provide coverage for responsibilities of co-workers when assigned or as needed.
Demonstrate working knowledge of all facets of the role, relevant regulations and organizational and departmental policies & procedures.
Escalate issues to management as appropriate.
Perform other duties as assigned to support the business.
Qualifications And Requirements
Strong understanding of medical terminology, insurance plans and authorization processes.
Bilingual English/Spanish is a plus.
Bachelor’s degree in healthcare administration, business or related field or minimum 3 year working in a healthcare setting managing or interpreting patient clinical notes or EMR files.
Excellent written and verbal communication skills.
Strong analytical and problem‑solving skills.
Previous experience in healthcare appeals or related field preferred.
Working in a fast‑paced environment for 2+ years is required.
High level of attention to detail and accuracy, with excellent investigative and research abilities.
Strong customer service orientation.
Ability to manage cases from multiple clientele programs and follow program business rules.
Proficiency with data entry functions and Microsoft applications required.
Ability to work independently and on a team.
Excellent communication, problem‑solving and customer service skills.
Strong organizational/interpersonal skills; attention to detail and multitasking proficiency.
Ability to use multiple PC monitors and navigate through several.
Physical Demands
Requires sitting, standing, and occasional light lifting.
The Perks Of Joining Our Team
Comprehensive health benefits: medical, dental, vision, short‑term/long‑term disability insurance, life insurance.
Paid vacation and holiday pay.
Employee Wellness Program.
401(k) with a company match.
Employee Assistance Program provides confidential support and counseling.
Employee referral program.
Recruitment Information
ProCare Rx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in‑person or via video conference invitations from official company emails. For inquiries, please contact our official recruitment team at HumanResources@procarerx.com.
Equal Opportunity Statement
ProCare Rx is an Equal Opportunity Employer.
#J-18808-Ljbffr
Create patient specific appeal letters by incorporating the reason of medical necessity for why the denial should be overturned.
Coordinate prescriber review and signature of completed letters.
Prepare and submit appeal documentation to insurance companies.
Communicate with patients, healthcare providers, and insurance companies to gather necessary information.
Work closely with provider office point of contact(s) to obtain updated information in order to create appeals, draft letters, as well as follow pharmacy workflow steps to provide a streamlined appeal process for offices and payers.
Maintain accurate and up-to-date records of all appeals processed.
Process fax queues, emails, answer incoming calls and adhere to all thresholds for authorization management.
Monitor appeal deadlines and ensure timely submission of all required documents.
Input accurate and clear data entry of call logs, important case notes and authorization details into CRM system.
Collaborate with internal departments to ensure comprehensive appeal support.
Research and stay current with changes in healthcare policies and regulations.
Provide status updates and resolution outcomes to involved parties.
Develop and implement strategies to improve the appeals process.
Assist in training new staff members on the appeals process.
Verify the accuracy and quality of data entry within authorizations prior to submission.
Safeguard, protect, and properly handle protected health information in accordance with all HIPAA laws and company policies/procedures.
Assess, prioritize and resolve client issues using good listening and comprehension skills.
Work cooperatively and provide coverage for responsibilities of co-workers when assigned or as needed.
Demonstrate working knowledge of all facets of the role, relevant regulations and organizational and departmental policies & procedures.
Escalate issues to management as appropriate.
Perform other duties as assigned to support the business.
Qualifications And Requirements
Strong understanding of medical terminology, insurance plans and authorization processes.
Bilingual English/Spanish is a plus.
Bachelor’s degree in healthcare administration, business or related field or minimum 3 year working in a healthcare setting managing or interpreting patient clinical notes or EMR files.
Excellent written and verbal communication skills.
Strong analytical and problem‑solving skills.
Previous experience in healthcare appeals or related field preferred.
Working in a fast‑paced environment for 2+ years is required.
High level of attention to detail and accuracy, with excellent investigative and research abilities.
Strong customer service orientation.
Ability to manage cases from multiple clientele programs and follow program business rules.
Proficiency with data entry functions and Microsoft applications required.
Ability to work independently and on a team.
Excellent communication, problem‑solving and customer service skills.
Strong organizational/interpersonal skills; attention to detail and multitasking proficiency.
Ability to use multiple PC monitors and navigate through several.
Physical Demands
Requires sitting, standing, and occasional light lifting.
The Perks Of Joining Our Team
Comprehensive health benefits: medical, dental, vision, short‑term/long‑term disability insurance, life insurance.
Paid vacation and holiday pay.
Employee Wellness Program.
401(k) with a company match.
Employee Assistance Program provides confidential support and counseling.
Employee referral program.
Recruitment Information
ProCare Rx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in‑person or via video conference invitations from official company emails. For inquiries, please contact our official recruitment team at HumanResources@procarerx.com.
Equal Opportunity Statement
ProCare Rx is an Equal Opportunity Employer.
#J-18808-Ljbffr