The Appeals Coordinator is responsible for gathering information, writing, and submitting appeals to insurance companies, making follow-up calls, and maintaining documentation. They use clinical criteria and documentation to develop appeal arguments and collaborate with other departments to impact clinical and financial outcomes.

This is an entry level position responsible for processing all release of information (ROI), specifically medical record requests, in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service.

Complete first past reviews of member medical records to capture active conditions that map to a risk value. Maintain compliance with CMS risk adjustment diagnosis coding guidelines. Assist with the intake and quality assurance of medical records as necessary. An assessment is required for this role.

Play a pivotal role in facilitating access to potentially life-saving treatments for patients worldwide. As the main point of contact for healthcare professionals seeking access to treatment under expanded access for their patients, you will guide HCPs through the entire EAP process, offering support at all steps.