Appeals Intake Coordinator

Apex Systems; Grand Rapids (MI); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

ESPP

401K with match

HSA

EAP 8 sessions

Discount programs

Certification discounts

Job summary

Everforth Apex Systems is seeking an Appeals Intake Coordinator to handle Medicare appeals and grievances remotely. You will triage, route, and document cases, coordinating with members and providers to support timely decisions.

Ideal candidates have 1 year of relevant experience, attention to detail, and HIPAA familiarity. Collaboration with Customer Service, Utilization Management, and Medical Directors is essential to ensure compliant triage and resolution.

Qualifications

• Must have high school diploma or equivalent.
• Preferred an Associate's degree.
• Minimum 1 year of relevant experience in appeals/grievances or health insurance.
• HIPAA compliance knowledge.

Responsibilities

• Triaging incoming appeals and grievances.
• Correspond with members, providers, and regulators regarding decisions.
• Coordinate with internal teams to triage inquiries.
• Ensure compliance with HIPAA and regulatory requirements.
• Support audits and monitoring activities.

Skills

Attention to detail

Communication skills

Learning new processes

Manual intake work

Regulatory awareness

Education

High school diploma or equivalent

Associate's degree (preferred)

Tools

EPIC

Job description

JOB DESCRIPTION

Job Title

Appeals Intake Coordinator

Work Arrangement

100% Remote

Expenses allowed: no

Corewell Health Equipment to be Provided.

Job Summary

The Appeals intake coordinator position is focused on the processing of incoming member and provider Medicare appeals and grievances. This team member will screen incoming complaints and appeals for level of urgency, benefit or medical necessity issues and other appropriate inquiries. This team member will assign the incoming concern to the appropriate analyst and may assist in investigations, documentation gathering, and correspondence as needed. This team member may also participate in auditing and monitoring activities as assigned. This team member will promote quality member care and customer service/satisfaction. This team member will interact with Customer Service, Utilization Management, Medical Directors, and other internal teams as necessary to effectively triage incoming complaints and appeals.

Essential Functions

• Triaging of incoming appeals & grievances
• Corresponds with members, providers and regulators regarding decisions and actions
• Communicate, collaborate and cooperate with internal and external stakeholders.
• Adheres to compliance and regulatory requirements
• Complies with HIPAA regulations
• Supports department-based goals which contribute to the success of the organization
• Reasoning ability to identify and define problems, collect data/information, establish facts, and draw valid conclusions, makes decisions and implements changes related to Federal regulations

Qualifications

• Required High School Diploma or equivalent
• Preferred Associate's Degree
• 1 year of relevant experience
• Health insurance/managed care experience performing Appeals and Grievances functions Required
• Must Have
• Attention to detail
• Fax processing
• Learning new processes
• Manual intake work
• Nice To Have
• Experience with EPIC
• Experience with Health Plan Appeals

Company Information

Everforth Apex is a world-class IT services company that serves thousands of clients across the globe. When you join Everforth Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRateds Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Benefits

Everforth Apex benefits overview: Everforth Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection.

We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure.

Everforth Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts.

In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA.

Equal Opportunity & Diversity Statement

Everforth Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership or any other characteristic protected by law. Everforth Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

ADA Accommodations

If you require an accommodation under the Americans with Disabilities Act to participate in an interview with a virtual recruiter or to use our website for a search or application, please contact our Benefits Department at [e-mail] or 804-523-8228. Please note that this contact information is strictly to be used for medical ADA accommodations and that no other inquiries will be answered.

Other Information

UnitedHealthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of Everforth Apex Systems.