CPC and CCS Appeals Coordinator

Job Summary

A company is looking for a Provider Appeals Coordinator/CPC/CCS, remote in Virginia or Florida.

Key Responsibilities

• Investigate and document member appeals and grievances in compliance with state laws and regulations
• Collaborate with Medical Directors on clinical appeals and the Appeals Manager on non-clinical appeals
• Ensure adherence to provider and group agreements throughout the appeals process

Required Qualifications, Training, and Education

• High School Graduate or equivalent is required
• Certified Professional Coder (CPC) certification is required
• Certified Coding Specialist (CCS) certification is required
• Minimum of 3 years of experience in Managed Care is required
• Previous provider appeals experience is preferred