Appeals Coordinator Cover Letter

Please consider me for the appeals coordinator opportunity. I am including my resume that lists my qualifications and experience.

In my previous role, I was responsible for word processing assistance to prepare reports, general correspondence, and other types of printed reports and materials.

My experience is an excellent fit for the list of requirements in this job:

• Experience with reimbursement instruments (standard claim forms) and medical claims handling (provider or payor) preferred
• Knowledge of industry terminology (CPT and ICD-9 codes) preferred
• Knowledge and experience with computer software, including Microsoft Word
• Knowledge of applicable medical coding/procedure codes, such as ICD-9 and CPT
• Experience in Utilization or Medical Review
• Experience with MHC, Hyperspace and IRCS
• Knowledge of local, state, federal and NCQA regulatory requirements for appeal processes
• Computer literate (Windows 95 and Microsoft Office 97)

I submit this application to express my sincere interest in the appeals coordinator position.

In the previous role, I was responsible for oversight of the team regarding clinical reviews/audits patient claims with medical necessity denials looking for patterns by services or by the ordering physician.

Please consider my experience and qualifications for this position:

• Mail all department letters related to appeals and State Hearings
• Track UPS mail delivery to appropriate parties to ensure timeframes and regulatory guidelines are met
• Track timeliness of member appeals and request an extension from the Grievance and Appeals Specialist if necessary to ensure timeframes are met
• Track appeals daily/monthly and report at Appeals meetings
• Interact with other departments such as Medical Management, Pharmacy and Grievance and Appeals
• Maintain chart storage
• Experience with managed care denial and appeal processes preferred
• Knowledge of InterQual and/or Milliman clinical guidelines

I submit this application to express my sincere interest in the appeals coordinator position.

In the previous role, I was responsible for in depth financial analysis on excel is a necessity.

I reviewed the requirements of the job opening and I believe my candidacy is an excellent fit for this position. Some of the key requirements that I have extensive experience with include:

• Knowledge of rules and regulations pertaining to hospital reimbursement
• Excellent analytical and critical thinking skills, details oriented
• Skilled in use of computers
• Positive work ethic, self motivated
• Experience working in ECIN and MPAC preferred
• Responsibilities are completed while ensuring regulatory compliance and HIPPA guidelines are met for Medicaid, Medicare and future lines of business
• Review and complete filing of all dental and pharmacy appeals within appropriate time frames
• Retrieve pharmacy documentation from RX Approver

In response to your job posting for appeals coordinator, I am including this letter and my resume for your review.

In my previous role, I was responsible for direct reports with guidance and educational tools in order to ensure compliance with NCQA, URAC, DOH, DOL and CMS.

Please consider my qualifications and experience:

• Document pharmacy appeals in Facets
• Request medical/dental records from providers
• Forward cases to the dental reviewer / pharmacist for review and determination
• Prepare all member appeals and forward to the Clinical Appeals nurse once the information is received
• Pull member denial charts from Medical Management
• Retrieve radiology documentation from RadMD
• Document radiology appeals in Facets
• Log, investigate, schedule and prepare State Hearings for the Clinical Appeals Nurse

I submit this application to express my sincere interest in the appeals coordinator position.

Previously, I was responsible for support for the Manager of Quality Management, Quality Management Department, Quality Management Medical Director, Quality Management Specialist and Patient Liaisons:.

My experience is an excellent fit for the list of requirements in this job:

• Excellent assessment, cognitive, and critical thinking skills
• Typing speed 35 words per minute without errors
• Experience working effectively with diverse groups, including culturally diverse, low-income populations
• Requires strong competency with Microsoft Office (specifically Microsoft excel and word)
• Non-invasive patient contact
• Normal or corrected-to-normal vision
• Previous experience with Appeals & Grievances
• Prior experience processing Medicare appeals and/or grievances