Optima Health – Va Bch

766122369 Appeal & Complaint Dept

Job Description

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.

Employment Status

Full time

Shifts

First (Days)

Requisition Id

114883BR

Job Posting

Optima Health is hiring an Appeals Coordinator
to join our team in Virginia Beach, VA.

Hours/Shift: 8-5p

Monday – Friday, Day shift, 40 hours/wk.

*Provider Appeal Coordinator positions require CPC Certification within 1 year of eligibility

Department/Position Overview:

We are seeking an experienced, professional Appeals Coordinator to help support our Optima leadership and our efforts to fulfill our mission on a daily basis. Professional, well-balanced, self-directing yet a collaborative team player with an unsurpassed administrative talent and keen sense of proactivity to drive a positive work environment are ideal. Additional key qualities include but are not limited to: multitasking, attention to detail, effective communication, and strong organizational skills to maintain multiple calendars from multiple leaders. Ability to sit for long periods of time performing job functions and strong Microsoft Office experience is a must.