Appeals Coordinator

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $22 - $24 / hour

⏰ Full Time

🟢 Junior

👻 Ghost score 0%

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Lucet

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

Lucet is a tech-enabled behavioral health company that combines human care teams and digital tools to connect individuals to timely, in-network mental health and substance-use care. It partners with health plans, employers, providers, and members through portals (employer/HR, member, provider, partner) and services such as EAP, care navigation, and provider resources to optimize access, quality, and value-driven behavioral healthcare.

📋 Description

• Process and document all aspects of appeal cases, including receipt date and time, investigation of appeal substance, and related records, comments, or information • Understand and apply standards established by NCQA, URAC, DOL, CMS, and federal and state laws • Understand member and provider rights and responsibilities related to claims and appeals • Assist Appeals Specialists with day-to-day Appeals Department operations • Research and document appeals and claims in compliance with regulatory requirements, business rules, and department guidelines • Support accurate determinations and issuance of compliant notices • Monitor appeal workflows and turnaround times • Ensure complete and accurate case documentation and timely case resolution • Collaborate with Appeals Specialists, customer service, and reimbursement teams • Communicate with members, providers, health plans, and internal stakeholders, escalating issues as needed • Maintain regulatory, organizational policy, ethical, confidentiality, and compliance standards • Meet productivity, accuracy, and turnaround-time goals

🎯 Requirements

• Associates degree and 1+ year of relevant healthcare experience • Equivalent combination of education and relevant healthcare appeals, claims, utilization management, or health plan experience may be considered in lieu of a degree, including high school diploma with 3+ years’ of relevant healthcare experience • 1+ years of healthcare appeals, claims, utilization management or related health plan experience • Proficient in Microsoft Office (Word, Excel, Outlook, etc.) and appeals documentation system • Demonstrated knowledge of applicable federal and state regulations, accreditation standards, privacy, confidentiality, and security requirements related to healthcare information • Ability to pass background check upon hire and throughout employment, including criminal, employment, education, sanctions, prohibited parties, sex offender registry, and 10-panel drug screening • Demonstrated flexibility and adaptability to changing processes and various software programs • Ability to manage multiple priorities in a fast-paced environment • Professional demeanor and ability to work collaboratively with multiple levels of professionals and line staff • Ability to participate positively in team processes and lead team activities • Excellent problem-solving, organizational, and attention-to-detail skills • Work from a single designated home office; travel between multiple residences or remote work locations is not supported • High-speed internet service with minimum download speed of 20 Mbps, upload speed of 5 Mbps, and maximum latency of 100 milliseconds, installed before starting • Quiet workspace with minimal background noise for calls

🏖️ Benefits

• Comprehensive health benefit options: Medical, dental, and vision coverage • 401(k) with competitive employer match • Company-paid life and disability insurance • Paid parental leave and wellbeing incentives • Generous paid time off, including volunteer time • Flexible spending accounts for healthcare and dependent care • Professional development opportunities and tuition reimbursement • Remote work flexibility (role-dependent) • Opportunity for meaningful growth, both personally and professionally • Company-provided equipment