Remote Healthcare Appeals Coordinator

Lucet; United States; Teletrabalho; USD 30 000 - 33 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Health benefits

401(k) match

Life & disability insurance

Parental leave

FSAs

Tuition reimbursement

Remote work flexibility

Resumo da oferta

Lucet in the United States is hiring an Appeals Coordinator to process and document appeal cases, ensuring regulatory compliance across NCQA, URAC, CMS, and DOL standards. You will collaborate with members, providers and internal teams to support timely, accurate determinations.

We offer remote work flexibility (role-dependent), competitive hourly pay between $22.15 and $24.00 plus an annual discretionary incentive, and comprehensive benefits including health, 401(k) match, life and disability

Qualificações

• Associates degree and 1+ year of relevant healthcare experience.
• Equivalent combination of education and relevant healthcare appeals, claims, utilization management, or health plan experience may be considered in lieu of a degree including high school diploma with 3+ years’ of relevant healthcare experience.
• 1+ years of healthcare appeals, claims, utilization management or related health plan experience.
• Proficient in Microsoft Office (Word, Excel, Outlook. Etc.) and appeals documentation system
• Demonstrated knowledge of applicable federal and state regulations, accreditation standards, privacy, confidentiality, and security requirements related to healthcare information.
• Ability to pass background check upon hire and throughout employment to include criminal felony & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree obtained), civil upper and lower search, 7-year employment report, federal criminal search, statewide criminal search, widescreen plus national criminal search, health care sanctions-state med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist).

Responsabilidades

• Process, research, and document appeals and claims in compliance with regulatory requirements, business rules, and department guidelines to support accurate determinations and issuance of compliant notices.
• Monitor appeal workflows and turnaround times, while ensuring complete, accurate case documentation and supporting timely resolution of cases.
• Collaborate with Appeals Specialists, customer service, and reimbursement teams to ensure appeals and claims are processed accurately, in compliance with policies, and resolved within required timeframes.
• Communicate effectively with members, providers, health plans, and internal stakeholders, escalating issues as needed to support timely resolution and positive outcomes.
• Maintain compliance with NCQA, URAC, CMS, DOL, and federal, state, and local regulations while adhering to organizational policies, ethical standards, and confidentiality requirements.
• Consistently meet productivity, accuracy, and turnaround time goals for appeal cases while upholding company values and compliance expectations.

Conhecimentos

Microsoft Office

Multitasking

Problem-solving

Attention to detail

Organizational skills

Formação académica

Associate degree

High school diploma with 3+ years healthcare experience

Ferramentas

Appeals documentation system

Descrição da oferta de emprego

Lucet in the United States is hiring an Appeals Coordinator to process and document appeal cases, ensuring regulatory compliance across NCQA, URAC, CMS, and DOL standards. You will collaborate with members, providers and internal teams to support timely, accurate determinations.

We offer remote work flexibility (role-dependent), competitive hourly pay between $22.15 and $24.00 plus an annual discretionary incentive, and comprehensive benefits including health, 401(k) match, life and disability