Overview
Appeals Assistant Jobs in Atlanta, GA at Kaiser Permanente
Title: Appeals Assistant
Company: Kaiser Permanente
Location: Atlanta, GA
Job Summary
Responsible for supporting the Appeals Department in processing member & provider appeals. Specifically, the Appeals Assistant is responsible for mail triaging and data entry into the Appeals Data Base and Tapestry. The individual in this position must be able to identify inconsistencies and interface directly with the appropriate parties to make the correct modifications. In addition, this position must work directly Marketing/Sales, Member Service, Claims and HCI. This position requires outstanding organizational skills to perform all functions in a timely manner, including general office operations and administrative support to the department.
Essential Responsibilities
- Open, date stamp and sort mail, and forward to Dekalb Tech for scanning. Re-route misdirected mail, as appropriate. Manage all electronic mail queues and CRM appeals pools.
- Responsible for entering all provider and/or member appeals requests into Tapestry and sending the appropriate acknowledgment letter to the appeal requestor via CRM.
- Support Work-at Home staff as needed with scanning, printing and mailing of appeals letters and cases.
- Respond to telephone calls from members and providers and triage the calls as appropriate.
- Perform other duties as assigned.
Experience
Basic Qualifications:
- Minimum of two (2) years of Member Services experience in a healthcare setting.
Education
- Associate degree in Business/Health Care Administration or two (2) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements
- Business letter writing experience.
- General knowledge of State, Federal and NCQA appeal regulations.
- Previous support experience, including knowledge of general office procedures and experience coordinating administrative services.
- Previous experience in database entry and management, including report generation; Ability to perform highly accurate data entry and trouble shoot problems.
- Knowledge of medical terminology.
- Excellent telephone and interpersonal skills.
- Experience in Microsoft Word & EXCEL for Windows.
- Ability to work in a team setting and independently. Strong collaboration skills a must.
- Knowledge of Kaiser Permanente benefits and membership contract parameters.
- Experience with IRCS, Tapestry/CRM.
- Managed care/Health care delivery system knowledge.
Preferred Qualifications
- N/A.
