Kaiser Permanente Appeals Coordinator in SEATTLE, Washington
Title: Appeals Coordinator Location: WA - Seattle-Renton-GH Campus - Southwest Job Number: 171904
Investigate, evaluate and make decisions regarding member appeals of health plan coverage denials for all Kaiser Permanente-owned health plans. Appeals may involve issues that are complex, high profile, precedent setting and include legal and/or risk management issues. Investigations include consultation with Legal, Contracts & Coverage, Membership and other various areas within Kaiser. Prepare and coordinate physician medical necessity reviews with the Clinical & Quality Review Unit and detailed case summary packets for review by Kaiser’s Appeals Committee and external review organizations. Accountable for documenting and resolving appeals, at multiple levels, in accordance with numerous and complex state, federal and voluntary regulatory requirements. In responding to member appeals, coordinators strive to maintain organizational integrity and to enhance/increase overall member satisfaction through appeal resolutions. All investigations and communications are HIPAA compliant.
This position will be located at the Renton or Spokane Office for the right candidate. Qualifications: Education Minimum Education Requirements Associate Degree or High School Diploma in combination with 2 additional years of experience in health plan customer service, appeals or working with complex regulatory requirements Preferred Education Associates Degree Knowledge/Skills Minimum Knowledge/Skills Requirements Excellent analytical, problem solving, verbal, written and interpersonal communication skills . Ability to manage multiple projects and deadlines simultaneously. Knowledge of and strict adherence to HIPAA rules . Preferred Knowledge/Skills Intermediate Kaiser Permanente Customer Service and/or Service Quality experience, including an understanding of GHC delivery system and insurance policies & processes. Knowledge of Medicare (CMS), ERISA, PBOR, NCQA & OIC regulations. Experience Minimum Experience Requirements 3 years Health plan member grievance and/or appeals handling experience . Preferred Experience Prior appeal handling and experience working with complex regulatory requirements. License/Certifications Minimum License/Certifications Requirements None Required Preferred License/Certifications None Required
Kaiser Permanente is an Equal Opportunity Employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, marital status, age, sexual orientation, gender identity or expression, or any other legally protected status. Job: Legal and Compliance Bargaining Unit: EWA Admin Exempt (non-union) FTE: 1 Schedule: Full-time Shift: Day Job Days of shift: M-F Hours of shift: 8 Travel: No Job level: Individual Contributor Job type: Standard Employee status: Regular J2W code: ADM1N
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.