Clinical Appeals Support Specialist

W3R Consulting; Northern (KY); Hybrid; USD 40,000 - 55,000; Full time

Job summary

W3R Consulting seeks a detail-oriented professional to support the Physical Health Appeals Department. Under supervision, you will assist members, clinicians, and physicians by processing appeals, answering inquiries, performing data entry, and coordinating across departments to close cases in the platform.

You will scrub appeals in MedHoK Appels, distribute work to Appeals clinicians, maintain production standards, and ensure HIPAA and corporate policies are followed while communicating with

Qualifications

• 1–2 years of college or 3 years of experience with automated systems.
• Experience coordinating member needs and assisting members.
• Knowledge of medical terminology.
• Database experience or PC applications experience.
• Strong customer service skills.
• Excellent verbal and written communications for member and physician coordination.

Responsibilities

• Receive and respond to inquiries from members, clinicians, or physicians.
• Distribute physical health appeals to Appeals clinicians.
• Maintain production requirements based on department needs.
• Provide non-clinical support to generate and close cases in the platform.
• Scrub appeals in the MedHoK Appels Application.
• Research next level of appeal and communicate results to members and providers.
• Upload clinical data to external review organizations when needed.
• Assign and delegate work items received via email or medical management system.
• Communicate professionally with coworkers, management, and customers.
• Comply with HIPAA and corporate policies; maintain confidentiality.
• Keep management informed about development in assigned areas.

Skills

Customer service

Medical terminology

Data entry

Communication skills

Automated systems experience

Education

Some college or associate degree

Job description

W3R Consulting seeks a detail-oriented professional to support the Physical Health Appeals Department. Under supervision, you will assist members, clinicians, and physicians by processing appeals, answering inquiries, performing data entry, and coordinating across departments to close cases in the platform.

You will scrub appeals in MedHoK Appels, distribute work to Appeals clinicians, maintain production standards, and ensure HIPAA and corporate policies are followed while communicating with