The Appeals Support Representative role directly supports the Clinical Appeals Specialist in the administrative functions of Denials and Appeals within the Utilization Review Team.This is a full-time remote position that will work Monday through Friday, 8:00am-4:30pm EST or 8:30-5:00pm EST.Responsibilities:
Complete outbound calls to payers for status updates on retro authorization requests and appeal submissions.
Interact with third party insurance representatives and utilize online sites to review retro authorization and appeal status.
Track and confirm weekly status updates on all outstanding appeal cases until final resolution.
Request, track, and receive payer correspondence regarding approvals and denials to include acknowledgment letters and determination letters.
Organize and scan all payer determination letters in KIPU charting system and update the Clinical Appeals Specialist within 24 hours of receipt.
Document final appeal outcomes as well as case details in KIPU chart system and appeal spreadsheet.
Responsible for obtaining patient and/or guardian signatures on required payer consent forms.
Submit retro authorization requests, provide support for retro SCA projects, and follow up on retro auth submissions until final resolution.
Identify problem cases and escalate issues to Clinical Appeals Specialist as appropriate.
Attend and participate in all monthly UR Team meetings and all quarterly Denials meetings.
Adhere to privacy and HIPAA guidelines.
Perform and/or assist with special projects as assigned.