Admin 2 - Appeals

Essential Duties and Responsibilities:
- Type/generate letters and other documents, as necessary.
- Assist in the preparation of reports.
- Create files in case management system.
- Update status of case in case management system.
- Fax and email file determination letters to interested parties.
- Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs and health plans to input necessary information into the system.
- Respond to incoming calls from clients, health plans, providers and enrollees regarding case status, questions about the program, and the appeals process.
- Perform research into invoicing issues and perform outreach to health plans regarding any unpaid invoices.

- Enter appropriate data into computer systems.

- Aid team members with case file maintenance.

- Enter appropriate information into automated systems for the tracking of all cases processed.

- Receive, process, and distribute incoming mail and faxes.

- Produce and maintain data reports and alert management of inconsistencies or issues.

- Serves as a point of contact for external inquiries from clients, enrollees, and health plans regarding case status.

- Prepare and disseminate case summaries to satisfy client reporting requirements.

- Validate application information against documents.

- Perform other duties as may be assigned by management.

- Perform audits of own work to ensure conformance with established procedures.

Minimum Requirements

- High School diploma, GED, or equivalent required.
- 2-4 years of experience required.

- 2-3 Years of applicable related job experience.

- Proficiency in Microsoft Suite, Adobe, and ability to accurately perform data entry.

- Excellent organizational, written, and verbal communication skills.

- Ability to perform comfortably in a fast-paced, deadline-oriented work environment.

- Ability to successfully execute complex tasks simultaneously with attention to detail.

- Ability to work as a team, as well as independently.

- Ability to work under standards-based performance measures.

- Ability to apply critical thinking skills.

- Ability to maintain confidentiality and security of all information processed.

- Ability to type 40 WPM.

- Familiarity with virtual machines to access external networks.

- Ability to work a schedule between the hours of 8:00am - 5:00pm PST Monday - Friday.

Preferred Skills an Qualifications:

- Associate's Degree.

- Resident of the state of California.

- Prior experience working with sensitive information to include protected data.

- Prior experience requesting medical records and processing documentation revisions per client request.

Please note: For this position Maximus will provide equipment to use.

Home Office Requirements:

- Internet speed of 25mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)

- Minimum 5mpbs upload speed

- Connectivity to the internet via Categ...