Overview: The Medicare Appeals Clerk is responsible for performing various clerical functions, including data entry, to support the Medicare Appeals team. This role includes entering appeals into the system, creating appeal packets for external review, making outbound phone calls to members and providers, and monitoring the department inbox.
Must-Have Requirements
Experience with Medicare Appeals
Day-to-Day Responsibilities
Perform data entry for appeals
Create appeal packets for external review
Make outbound phone calls to members and providers
Monitor the department inbox
Sort, date stamp, and distribute mail/faxes/packages daily within set time frames
Assist in maintaining files as needed
Scan and print documents as requested
Mail and file all department documents accurately and efficiently
Keep printers and printer areas stocked
Prepare mailings and packages
Coordinate, upload, and maintain department documents for multiple health plans using multiple applications
Provide clerical support to various teams, including PIM, Recovery, Medicare, Legal Affairs, Medical Affairs, and Member Services
State Plan / Department Specific Duties And Responsibilities
PIM:
Assign work from incoming Outlook boxes based on defined assignments
Recovery:
Data entry into department applications with accuracy and efficiency
Medicare:
Order new hire equipment (e.g., cell phones, computers, security access)
Listen to sales records and capture pertinent information
Order department supplies as requested
Create help desk tickets and act as liaison for facilities department requests
Legal Affairs:
Create binders as requested
Create help desk tickets
Answer department phones
Medical Affairs:
Contact members and providers regarding outreach materials as needed
Data entry into department applications with accuracy and efficiency
Member Services:
Compile and post departmental scorecards
Assist with basic reporting needs
Stock and maintain department supplies
Knowledge/Skills/Abilities
Excellent verbal and written communication skills
Ability to abide by Managed Care Organization's policies
Maintain regular attendance based on the agreed-upon schedule
Maintain confidentiality and comply with HIPAA
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers
Demonstrated adaptability and flexibility to changes and responsiveness to new ideas and approaches
Required Education
High School Diploma or equivalent
Required Experience
0-2 years of experience
PC experience in a Windows environment
Experience using Microsoft Word
Filing experience preferred
Experience with customer service
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Staffing and Recruiting
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