Coordinator 2 – Appeals

Job Description

JOB DETAILS

REQUIREMENTS

• High School Degree or equivalent required.
• 2-4 years of related professional experience required.

RESPONSIBILITIES

• Analyze data submitted for Independent Medical Review.
• Conduct fact finding and analyses on those cases deemed complex in nature or requiring adjudication; apply established procedures where the nature of the system, feasibility, computer equipment and reporting tools have not already been decided.
• Track and meet required deadlines for complex cases or other assigned tasks.
• Assist leadership through research of data and/or authoring reports.
• Analyze data using all applicable state law, state regulations, process documents, and other sources as defined by the client contract.
• Work independently on specific situations or on a team to resolve problems and deviations according to current established practices; and obtains advice where precedents are unclear or not available from the client.
• Answer and respond to phone calls/emails from participants in the Independent Medical Review process.
• Assist others or provide on-the-job training or act as a mentor to production staff.

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