Clinical Appeals Coordinator

Job Description

The Appeals Coordinator is responsible for gathering all information required on an appeal, writing, and submitting the appeal to insurance company and for all follow up phone calls and documentation of these appeals.

Responsibilities

• Confirm prescriber/ patients request to appeal.

• Verify the information needed by the plan for an appeal and where to submit.

• Gather all necessary information from prescriber office to complete the appeal.

• Responsible for writing the letter of appeal.

• Notifying appropriate staff of approved/denied medications.

• Process/reverse online claims as required.

• Responsible for maintaining required spreadsheets if applicable.

• Responsible for all follow up phone calls to the insurance company or

• prescriber office for status of appeal or request for additional information.

• Responsible for all documentation of appeal statuses into CPR+ progress notes.

• Update sales staff with pertinent information.

• Participate and perform other duties as assigned by leadership

Skills & Abilities

• Demonstrate the BioPlus C.A.R.T. values.

  • Competence

  • Accountability

  • Respect

  • Trust

• Excellent Computer Skills.

• Knowledge of medical terminology.

• Excellent communication skills.

• Ability to work cooperatively and be a liaison between departments when needed.

• Professional Image

Qualifications

QUALIFICATIONS & ABILITIES:

• High School Diploma or Equivalent.

• At least 1 year experience working with appeals, prior authorizations, or billing.

• Specialty pharmacy experience preferred.

Additional Information

BioPlus offers competitive compensation packages including health care, 401(k), growth potential, and a challenging and exciting work environment. 

BioPlus is an Equal Opportunity Employer