UM Appeals Processing Assistant

Competitive Compensation & Benefits Package!

This position is eligible for:

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

Office Location: Gastonia, NC; Hybrid position (required to come into the office 2 days per week)

Primary Purpose of Position: This position provides administrative and office/procedural support work for the Appeals unit by relieving the department of routine office tasks. It also provides departmental support by creating, maintaining, and/or distributing appeals, reports, spreadsheets, and databases.

Role and Responsibilities:

• Provide administrative support including copying, filing, mailing, meeting coordination, and other duties as needed.
• Process reconsiderations/appeals in adherence to appeal timeframes.
• Create and track appeal information.
• Provide rotating back-up support for the front desk Administrative Assistant.
• Assist appeals process by assembling appeal folders for UM Supervisors/Appeal Clinicians.
• Coordinate and schedule mediation/formal hearings; record and document mediation summaries.
• Track Notice of Decision letters and outcomes in spreadsheets.
• Maintain filing system for all appeal files.
• Mail acknowledgement letters of receipt.
• Participate in telephone workgroup rotation and assist with phone calls.
• Screen and route mail for Appeals department; maintain returned letters log.
• Ensure accurate data entry and maintenance in all applicable systems/databases.
• Promote positive work environment and direct questions/concerns appropriately.
• Complete other supportive duties as assigned by supervisor.

Knowledge, Skills, and Abilities:

• Considerable knowledge of office techniques and technology.
• Basic recognition and knowledge of medical terminology.
• Excellent skills in Microsoft Office (Word, Excel, Outlook).
• Effective oral and written communication.
• Ability to gather information and produce reports.
• Strong interpersonal relationships.
• Ability to analyze and interpret policy and procedural guidelines.
• Organize workflow and coordinate activities.
• Effective problem-solving.
• Manage and uphold confidentiality and integrity of sensitive data.

Education and Experience:

• High School graduate or equivalent.
• Two years of administrative support experience in healthcare or behavioral healthcare setting, or equivalent combination of training and experience.
• Previous experience working with protected health information preferred though not required.