New York Appeals Coordinator

Job Summary

A company is looking for an Appeals and Grievances Coordinator.

Key Responsibilities

• Prepare case files for clinical review by gathering documentation and conducting appeal research
• Perform administrative activities including generating determination and authorization notification letters
• Serve as a liaison with providers and members during the appeal process and ensure compliance with regulatory guidelines

Required Qualifications

• High School Diploma or GED
• Bachelor's degree preferred
• Knowledge of related New York state and federal regulations highly desirable
• Proficiency in Microsoft Office required
• Knowledge of claims payment processes and claims data systems