Remote Physical Health Appeals Coordinator (Contract)

VIVA USA Inc; United States; Remote; USD 42,000 - 64,000; Full time

Job summary

VIVA USA Inc. seeks a remote-based support specialist to assist members, clinicians, and physicians in processing Physical Health clinical appeals. The role involves inquiries, outbound calls, data entry, and cross-department collaboration to resolve cases.

You will scrub appeals, research next levels of appeal, and liaise with external review bodies when necessary, while upholding HIPAA and company policies.

Qualifications

• 1 or 2 years college OR 3 years of experience with automated systems.
• Experience coordinating member needs and providing assistance to members.
• Knowledge of medical terminology.
• Database experience or PC applications experience.
• Customer service skills; verbal and written communications.

Responsibilities

• Respond to inquiries from members, clinicians, or physicians to support the physical health appeals department.
• Distribute physical health appeals to the Appeals clinicians based on assigned parameters.
• Maintain production requirements based on department needs.
• Support clinical team with non-clinical tasks to generate and close cases.
• Scrub appeals in the MedHoK Appels system and research next level of appeal.
• 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, customers, etc.
• Comply with HIPAA and corporate policies; maintain confidentiality.
• Maintain communication with management and perform special projects as required.

Skills

Customer service

Verbal communication

Written communication

Data entry

Interpersonal skills

Education

Some college coursework (1–2 years)

3 years of experience with automated systems

Job description

VIVA USA Inc. seeks a remote-based support specialist to assist members, clinicians, and physicians in processing Physical Health clinical appeals. The role involves inquiries, outbound calls, data entry, and cross-department collaboration to resolve cases.

You will scrub appeals, research next levels of appeal, and liaise with external review bodies when necessary, while upholding HIPAA and company policies.