City/State

Work Shift

Overview:

Sentara Health Plans is hiring an Appeal Coordinator- Remote in Virginia and Florida!

Status: Full-timepermanent position (40 hours)

Standard working hours: 8am to 5pm EST M-F.

Location: Remote in Virginia or Florida.

Job responsibilities:

• Responsible for the investigation and documentation of member appeals and grievances in compliance with State law applicable rules and regulations and provider and group agreements. Works closely with the Plans Medical Directors who are responsible for all decision regarding clinical appeals/ grievances and the Appeals Manager who is responsible for non-clinical appeals and grievances.

Education:

• HS - High School Grad or Equivalent REQUIRED

Certification/Licensure:

• Must have Certified Professional Coder (CPC) and Certified Coding Specialist (CCS) from the American Health Information Management Association (AHIMA)

Experience:

• Managed Care- 3 yearsREQUIRED

• Previous provider appeals experience preferred

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans as well as Individual & Family Health Plans Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network including specialists primary care physicians and hospitals.

We offer programs to support members with chronic illnesses customized wellness programs and integrated clinical and behavioral health servicesall to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People Quality Patient Safety Service and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply please go to and use the following as your Keyword Search: JR-87716

#Indeed

Talroo - Health Plan

Keywords: Health Plan Healthcare MCO Managed Care Remote Virginia Richmond Virginia Beach VA Appeals Claims Grievance Pre-authorization Provider CPC COC Certified Professional Coder Certified Coding Specialist

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30000-member workforce. Diversity inclusion and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission to improve health every day this is a tobacco-free environment.

For positions that are available as remote work Sentara Health employs associates in the following states:

Alabama Delaware Florida Georgia Idaho Indiana Kansas Louisiana Maine Maryland Minnesota Nebraska Nevada New Hampshire North Carolina North Dakota Ohio Oklahoma Pennsylvania South Carolina South Dakota Tennessee Texas Utah Virginia Washington West Virginia Wisconsin and Wyoming.