What are the responsibilities and job description for the Appeals Coordinator position at Sentara?
Sentara Health Plans is currently seeking a Full-Time day shift,
Appeals Coordinator in Tidewater, VA area.
Position is hybrid remote and requires 2-3 days a week in office.
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.
Job Requirements
- High School Grad or Equivalent
- Managed Care 3 years
- Microsoft Word, Microsoft Excel, Microsoft Access required.
Sentara Health Plan is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier.
Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans, and plans serving Medicare and Medicaid enrollees.
With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, 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.
Benefits: Sentara offers an attractive array of full-time benefits including Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B with matching funds, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more.
Along with competitive salary we also offer the following benefits:
Adoption, Infertility, and Surrogacy Reimbursement
Educational Assistance Programs, including Tuition Assistance
Emergency Back-Up Care
Financial Wellness Tools, including extra student debt payments on your student loans.
Medical, Dental, and Vision Benefits
Paid Annual Leave (PAL)
Paid Parental Leave
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!
keywords: appeals, grievances, coordinator, managed care, health plan
- High School Grad or Equivalent
- Managed Care 3 years
- Microsoft Word
- Microsoft Access
- Microsoft Excel
Salary : $1 - $1,000,000
