Job Description

Sentara Health Plans is hiring an Appeal Coordinator- Remote in Virginia and Florida!
Status: Full-time, permanent 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 Plan's 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 years REQUIRED
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 services--all 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

Skills Required