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Clinical Appeals Coordinator
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Robert Half
Ontario, CA (In Person)
Full-Time
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Job Description
Description We are looking for a detail-oriented Clinical Appeals Coordinator to support clinical appeals activity for a health insurance organization in Eden Prairie, Minnesota. This Long-term Contract opportunity is well suited for someone who can manage high-volume documentation, coordinate with provider offices, and keep appeal-related records accurate and current. The person in this role will help ensure information is collected promptly, tracked carefully, and processed within required service timelines while working primarily remotely with occasional office visits as needed.
Responsibilities:
- Review and manage clinical appeal files, ensuring each case is documented accurately and updated in the appropriate databases.
- Communicate with provider offices and other involved parties to obtain missing records, confirm required information, and support timely case progress.
- Track request deadlines closely and follow up on outstanding items to keep work moving within established health plan turnaround expectations.
- Maintain organized records for incoming and outgoing documentation, including receipt, status updates, and final case support materials.
- Perform high-volume data entry with a strong focus on accuracy, completeness, and quality standards.
- Support mail-related processing activities when needed, including occasional trips to the Eden Prairie, Minnesota office for physical document handling.
- Participate in training and apply department procedures consistently to help maintain compliance and service quality.
- Collaborate with internal teams and external contacts to resolve documentation gaps and keep appeals work aligned with operational requirements.
- Experience in medical insurance, utilization management, claims, appeals, or a closely related healthcare operations environment.
- Strong documentation and data entry skills with the ability to maintain accurate information across multiple systems.
- Ability to manage deadlines effectively and prioritize work based on varying turnaround requirements.
- Comfortable communicating with provider offices and other stakeholders in a clear and timely manner.
- Working knowledge of health plan processes and regulated case handling standards.
- High attention to detail and commitment to quality when reviewing records and updating databases.
- Ability to work independently in a primarily remote setting with occasional on-site support as needed.