Compl/Appeals Clerical Lead, El Paso Health - University Medical Center of El Paso

Job Summary
Leads the Complaints and Appeals Clerks and provides clerical support to the daily operations of the Complaints and Appeals Department. Ensures complaints and appeals are scanned, saved, entered and acknowledged in the Management Information System (MIS) Complaints and Appeals (A&G) module and uploaded to software platforms such as OnBase. Determines the difference between complaints, claim appeals and adverse determination appeals to handle accordingly or route to the appropriate Complaints & Appeals Associate for processing. Processes Member complaints for all product lines.

Skills
1. Bilingual (English/Spanish) languages preferred.
2. Excellent oral/written communication skills.
3. Ability to type 45 wpm with a minimum of two years word processing experience and the ability to use a fax server, copier and other general office equipment.
4. Computer knowledge within area of assigned responsibility preferred.
5. Ability to work well in a fast-paced environment and establish priorities.
6. Ability to work in a professional and courteous manner.
7. Demonstrated initiative in researching information relating to state regulations and standards.
8. Proficiency in all phases of duties performed.
9. Familiar with QXNT application, including Appeals and Grievance (A&G) module.
10. Familiar with OnBase application.

Work Experience
Three years of experience in an office setting is required. Must have experience with word processing, including but not limited to, Microsoft software such as Word, Excel, and Outlook. Familiarity and/or exposure to Medicaid, CHIP, Medicare, or Third-Party Administration preferred.

License/Registration/Certification
None

Education and Training
High school diploma or equivalent required.

PI251057339