Physician / Administration / Texas / Locum or Permanent / Clinical Administration Coordinator Dallas TX Job

• Provides data entry, filing, tracking time frames and status of case files and mailing letters to patients and providers
• Reviews denials and determines whether the decisions are retro/ claims DOS or prospective DOS, and whether they are NCB or medically necessary
• Sorts appropriately
• Monitors system approval queues and prints member letters, ensuring that all approvals are printed and mailed by end of business day
• Prepares envelopes and letters for mailing according the UM policy
• Receives appeal requests from health plans and/ or QIO, logs requests, researches and provides requested information
• Works with claims department to redirect claims related appeal requests.
• Generates reports for analysis by department using the data entry system
• Assists with CMS organization determination reports as needed

This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. You also must be able to work a flexible schedule that includes evening hours and Saturdays.