Our Client, a Health Insurance company, is looking for a Medical Appeals Representative for their Baton Rouge, LA location. Responsibilities:

+ Ensures the timely and accurate processing of all medical appeals by performing intake review, prioritization, and case coordination activities. Supports departmental workflow by organizing, distributing, and tracking appeals while ensuring compliance with PPACA, Department of Insurance (DOI), and URAC guidelines.

+ Accountabilities and Essential Functions

+ Reviews incoming appeal requests (mail, fax, electronic) to determine eligibility and classification

+ Differentiates between expedited and standard appeals to ensure compliance with regulatory timeframes

+ Establishes and maintains appeal cases within designated systems (e.g., EPIC)

+ Prioritizes, organizes, distributes, and tracks appeals to appropriate clinical staff

+ Coordinates workflow to ensure timely process...