Appeals Coordinator

The Appeals Coordinator processes and documents all aspects of appeal cases including receipt date and time of an appeal, full investigation of the substance of the appeal and any records, written comments or information pertaining to the appeal. This position requires understanding standards set forth by the National Committee for Quality Assurance (NCQA), the Utilization Review Accreditation Commission (URAC), Department of Labor (DOL), Centers for Medicare and Medicaid Services (CMS), Federal and State laws.

The Appeals Coordinator position is accountable for understanding Member and Provider Rights and Responsibilities and structure surrounding claims and appeals. The Appeals Coordinator interfaces with members, providers and clients.