Experienced Remote Appeals Specialist – Member and Recipient Support for Vaya Health

Introduction to Vaya Health and the Role

Vaya Health is a leading organization dedicated to providing exceptional support and services to its members and recipients. As a key player in the healthcare industry, Vaya Health is committed to delivering high-quality solutions that make a meaningful difference in people's lives. We are now seeking an experienced and skilled Appeals Specialist to join our team, working remotely to provide essential support to our members and recipients. This is an exciting opportunity for a highly organized and customer-focused individual to make a real impact in a dynamic and growing organization.

Job Overview

The Appeals Specialist will be responsible for conducting and supporting the functions of the Member and Recipient Appeals Team, managing peer review, denial, and appeal functions for Vaya Health. This will involve generating member and recipient notification letters, posting and mailing correspondence, and scanning and uploading documents to member and recipient files and Vaya databases. The successful candidate will also be required to answer and respond to phone calls, emails, and faxes from staff, providers, members, and recipients, and community members who have needs related to administrative and clinical denials and appeal functions.

Key Responsibilities

• Preparing, copying, printing, and mailing denial and appeal notifications to members and recipients
• Reviewing clinical rationales for required reading level to ensure clarity and accuracy
• Receiving and validating appeal requests, ensuring timely and efficient processing
• Proofreading and verifying accuracy of information for member and recipient correspondence to maintain high standards of quality
• Coordinating and tracking appeal referrals to appeal Peer Reviewers, providing technical and administrative support as needed
• Providing peer review desk coverage to UM staff for referrals to initial Peer Reviewers, ensuring seamless operations
• Preparing and maintaining initial and first-level denial and appeal files, auditing all levels of Member and Recipient denial and appeal files for accuracy and compliance
• Answering and responding to phone calls, voicemails, emails, and faxes from staff, providers, members, and recipients, and community members who have questions and needs related to clinical denial and appeal functions
• Preparing and submitting denial and appeal information to designated tracking spreadsheets and databases, documenting and reporting anomalies or errors to the Member and Recipient Appeals Manager

Essential Qualifications and Education Requirements

To be successful in this role, you will need to possess a High School diploma or GED, with an Associate or Bachelor's degree in Business Management or Certification in Allied Health field preferred. You will also require 2-5 years of clerical and administrative support experience in an allied health and/or behavioral health setting, with a strong understanding of the healthcare industry and its regulations.

Skills and Competencies

• Strong attention to detail and superior organizational skills, with the ability to prioritize competing deliverables and complete projects on time
• Excellent telephone and customer service skills, with a professional and collaborative approach to working with team members, other Vaya staff, and external parties
• Proficient technology skills in Microsoft Office suite, including Word, Excel, and Teams, with the ability to adapt to new systems and software as needed
• Ability to multitask and prioritize competing demands, with a flexible and responsive approach to changing priorities and deadlines
• Strong analytical and problem-solving skills, with the ability to think critically and make informed decisions

Career Growth Opportunities and Learning Benefits

At Vaya Health, we are committed to supporting the growth and development of our employees, providing opportunities for training, education, and career advancement. As an Appeals Specialist, you will have the chance to work with a talented and dedicated team, developing your skills and expertise in a dynamic and supportive environment. You will also have access to a range of learning resources and professional development opportunities, helping you to stay up-to-date with the latest industry trends and best practices.

Work Environment and Company Culture

Vaya Health is a values-driven organization, committed to making a positive impact in the lives of our members and recipients. We believe in fostering a culture of respect, empathy, and inclusivity, where every employee feels valued and supported. As a remote worker, you will be part of a virtual team, working collaboratively with colleagues across different locations to achieve our goals and objectives. You will also have the opportunity to participate in virtual training sessions, team meetings, and social events, helping to build connections and relationships with your colleagues.

Compensation, Perks, and Benefits

We offer a competitive salary and benefits package, with opportunities for overtime compensation and professional development. You will also have access to a range of perks and benefits, including flexible working hours, virtual wellness programs, and employee recognition schemes. We believe in recognizing and rewarding the hard work and dedication of our employees, providing a supportive and inclusive work environment that allows you to thrive and grow.

Conclusion

If you are a motivated and customer-focused individual, with a passion for delivering exceptional support and services, we encourage you to apply for this exciting opportunity. As an Appeals Specialist at Vaya Health, you will have the chance to make a real difference in the lives of our members and recipients, working with a talented and dedicated team to achieve our goals and objectives. Don't hesitate to apply – we look forward to hearing from you!

Apply now and take the first step towards a rewarding and challenging career with Vaya Health. Visit our Career Center to submit your application and learn more about this exciting opportunity. We can't wait to welcome you to our team!

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