Job Description

Location: Hybrid 3 days in Charlotte office

Join our Judi Health TPA team as a Senior Coordinator, Appeals, where you will play a pivotal role in monitoring, handling and escalating appeals and provide support to multiple parties of our TPA team. You will help with daily operations of our TPA, including areas such as appeals, root cause analysis, IDR, and more. This position offers the opportunity to influence operational best practices and contribute to a team that is redefining operational excellence in the healthcare space.

Position Responsibilities:

• Drives cross-functional collaboration with the product/dev team as well as additional stakeholder teams to ensure enhancements to Judi drive operational efficiency and support on-going client needs
• Investigate and resolve client, patient, or provider disputes regarding coverage, medical claims and service grievances including NSA and IDR.
• Monitor appeal deadlines and ensure all communications and resolutions comply with regulatory guidelines
• Accurately log case information, upload documentation, and maintain detailed, up-to-date records of all processed appeals
• Make recommendations to streamline the work processes and systems that daily operations to create efficiency and quality outcomes
• Identify, troubleshoot, and escalate any operational and systemic discrepancies immediately to avoid care disruption
• Develops standard policy and procedures, training materials and provide education for training and presentation to cross-functional teams
• Maintain acceptable and appropriate quality levels and production SLA response time
• Support general business or team needs, as assigned
• Responsible for adherence to the Judi Health of Conduct including reporting of noncompliance.

Required Qualifications:

• Bachelor’s degree preferred
• 3+ years of TPA / health plan experience in Claims Adjudication, Appeals, or other applicable department needs.
• Advanced knowledge of appeals workflows, including documentation requirements for Providers and Administrators
• Ability to interpret multiple client plan designs and SPDs
• Familiarity with NSA regulations and the IDR Process
• Advanced knowledge of CPT, HCPCs, ICD-10, CDT coding a plus
• Self-funded plans, Medicare/Government programs and ERISA experience preferred
• Tremendous attention to detail, ability to shift priorities easily and ability to work in a high paced, deadline drive environment.
• Exceptional written and verbal communication skills