UM RN Appeals Coordinator - Work from Home

Job title
UM RN Appeals Coordinator - Work from Home

About Sagility

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members.

The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics.

Sagility has more than 25,000 employees across 5 countries.

Job title:

UM RN Appeals Coordinator - Work from Home

Job Description:

About Sagility

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members.

The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics.

Sagility has more than 25,000 employees across 5 countries.

Job Description:

BroadPath, a Sagility Company, is hiring UM RN Appeals Coordinator to join our remote team! Claims Processors are responsible for the accurate and timely entry, review, and resolution of medical claims ranging from simple to moderately complex.

This includes reviewing front-end claims and validating information submitted by patients or providers seeking reimbursement from the insurance company.

All claim processing must align with CMS guidelines and client-specific policies and procedures.

Schedules, pay rates, and program details may vary based on business needs and client assignment.

Compensation Highlights


* Base Pay: up to $50 per hour


* Pay frequency: Weekly pay

Schedule Highlights


* Training Schedule: 2 weeks, Monday – Friday; 8:00 AM - 5:00 PM CST



* Production Schedule: Monday – Friday; 8:00 AM - 5:00 PM CST (Flexible)

Responsibilities

A.

Performs necessary review to ensure compliance with HHSC and other regulatory entities


* Collaborate: Partners with the physician team to identify strategies for action and determine appropriate guideline citations or responses based on the category of denial


* Develop: Creates training materials and examples for nursing staff to enhance understanding of criteria application, benefit use, and the appeal, External Medical Review (EMR), and Fair Hearing processes


* Coordinate: Ensures continuity of care needs are met and advocates on behalf of Members and families for out-of-network authorization approvals
Implement: Identifies problems, barriers, and opportunities within processes and develops resolutions or revisions as needed


* Evaluate: Conducts quarterly assessments of appeal status and program activities, preparing reports for both the State of Texas and internal review


* Analyze: Reviews requests against regulatory and decision-making guidelines and benefit allowances, implements...