Medicare Appeals Clerk

Job Title: Medicare Appeals Clerk

Location:
100% Remote

Time Zone Requirements: PST

Job Type: Full-Time

Schedule: 9:00 AM PST - 5:30 PM PST, Wednesday to Sunday

Overview: The Medicare Appeals Clerk is responsible for performing various clerical functions, including data entry, to support the Medicare Appeals team. This role includes entering appeals into the system, creating appeal packets for external review, making outbound phone calls to members and providers, and monitoring the department inbox.

Must-Have Requirements:

• Experience with Medicare Appeals

trong>Day-to-Day Responsibilities:

• Perform data entry for appeals
• Create appeal packets for external review
• Make outbound phone calls to members and providers
• Monitor the department inbox
• Sort, date stamp, and distribute mail/faxes/packages daily within set time frames
• Assist in maintaining files as needed
• Scan and print documents as requested
• Mail and file all department documents accurately and efficiently
• Keep printers and printer areas stocked
• Prepare mailings and packages
• Coordinate, upload, and maintain department documents for multiple health plans using multiple applications
• Provide clerical support to various teams, including PIM, Recovery, Medicare, Legal Affairs, Medical Affairs, and Member Services

State Plan / Department Specific Duties and Responsibilities:

• PIM:
  • Assign work from incoming Outlook boxes based on defined assignments
• Recovery:
  • Data entry into department applications with accuracy and efficiency
• Medicare:
  • Order new hire equipment (e.g., cell phones, computers, security access)
  • Listen to sales records and capture pertinent information
  • Order department supplies as requested
  • Create help desk tickets and act as liaison for facilities department requests
• Legal Affairs:
  • Create binders as requested
  • Create help desk tickets
  • Answer department phones
• Medical Affairs:
  • Contact members and providers regarding outreach materials as needed
  • Data entry into department applications with accuracy and efficiency
• Member Services:
  • Compile and post departmental scorecards
  • Assist with basic reporting needs
  • Stock and maintain department supplies

Knowledge/Skills/Abilities:

• Excellent verbal and written communication skills
• Ability to abide by Managed Care Organization's policies
• Maintain regular attendance based on the agreed-upon schedule
• Maintain confidentiality and comply with HIPAA
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers
• Demonstrated adaptability and flexibility to changes and responsiveness to new ideas and approaches

Required Education:

• High School Diploma or equivalent

Required Experience:

• 0-2 years of experience
• PC experience in a Windows environment
• Experience using Microsoft Word
• Filing experience preferred
• Experience with customer service