Member Appeals Associate, Medicare Appeal Coordinator
625 State St, Schenectady, NY 12305, USA ● Rochester, NY, USA
Req #2056
Tuesday, June 4, 2024
Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds—tech people, numbers people, even people people—working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference—it’s time to make a healthy career move to MVP!
Status: Full-time, Non-Exempt
Under the direction of the Appeals Manager:
Thoroughly investigates and resolves member appeals and CTM’s in a professional and timely manner following departmental and company processes and within time limits set forth by CMS guidelines. Monitors appeals for trends and potential service improvement opportunities. Duties include: Investigates each appeal by gathering pertinent information from members, providers, facilities and internal resources in order to respond to each appeal within the designated time requirements. Sends timely resolution letters for cases. Serves as primary case contact for member, provider, and medical director reviewer questions or requests. Monitors cases for trends, and reports trends to Manager. Suggests service improvement initiatives, if appropriate. Processes and responds to member correspondence, identifying trends and presenting those to Manager. Experience working with IRE’s (currently Maximus) and ALJ’s. Educates members and providers on MVP policies, procedures and member benefits. Provides appeal process training to MVP staff. Performs claims and coding research to facilitate processing of appeals identifying trends and presenting those to Manager. Works closely with MVP departments, vendors and external customers to resolve member appeal issues. Maintains working knowledge of Medicare Evidence of Coverage, CMS guidelines, as well as regulatory changes, to ensure correct processing of appeals. Properly and fully documents member appeal including full documentation of contacts made or received, as well as any correspondence sent/received. Sends clearly written detailed correspondence to members and providers for each appeal or correspondence, in a timely manner. Communicates clearly and effectively in either written correspondence or orally, and demonstrates appropriate level of tact and diplomacy with internal/external contacts. Exhibits high level of conflict resolution skills. Maintains and updates appeal and correspondence databases. Effectively adapts to changes and understands key business relationships which may affect the Appeals Department. Performs other duties as assigned.
POSITION QUALIFICATIONS
Minimum Education: 2-4-year degree or equivalent amount of education and work experience
Minimum Experience: Experience in a Medicare Appeals environment Part C and D and at least 1 year of experience in a Medicare health insurance environment.
Required Skills
• Medicare Appeals Experience
• Extensive knowledge of Medicare Managed Care Part C and Part D, including health care benefits, regulations, medical and administrative policies, and claims payment processes
• Demonstrated strong verbal and written communication, organizational, analytical, and interpersonal skills
• Strong commitment to customer service and understanding and responding to customer needs
• Strong problem solving skills and ability to thoroughly follow issues through to resolution
• Ability to maintain a high level of discretion in dealing with confidential member medical and company-sensitive information
• Demonstrated use of Microsoft Office suite products, including Access and Outlook
Preferred Skills
• Experience working with IRE’s and ALJ’s
• Demonstrated knowledge of medical management documentation/tracking systems such as Facets, Macess, and CareRadius
About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve.
At MVP, we are committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. Specific employment offers and associated compensation will be made individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.
In addition, we offer a comprehensive benefits package that includes:
- Considerable paid time away from work including PTO (Paid Time Off), sick time, service time off, paid holidays, and floating holidays, allowing you to take time off when it suits you best.
- Competitive 401(k) employer matching and profit-sharing program to help you save for your retirement.
- Low premium health benefits including medical, dental, and vision coverage to support your well-being and that of your family.
- Life insurance and disability coverage to ensure financial security for you and your dependents.
- An array of optional benefit plans such as accident insurance and specified disease coverage to protect you from the unexpected.
- Full tuition reimbursement (up to the IRS limit) for approved courses and programs that support continuous learning.
- A best-in-class employee Well-Being program to support all dimensions of your health and wellness.
MVP Health Care analyzes the latest market data to determine employee compensation. Compensation figures listed in a job posting are subject to change as new market data becomes available. The salary range, other compensation, and benefits information is accurate as of the date of this posting. MVP Health Care reserves the right to modify this information at any time, subject to applicable law. More detailed information about totalcompensation and benefits will be provided during the hiring process.
MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com
Please apply and learn more – including how you may become a proud member of our team.
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Job Family
Quality Improvement
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Pay Type
Hourly
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Min Hiring Rate
$20.00
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Max Hiring Rate
$33.12