Appeals & Grievance Coordinator I

Appeals & Grievance Coordinator I--------------------------------------------------------------- The Appeals and Grievance Coordinator I position is responsible for coordinating appeals and/or grievances at the entry level. This includes tracking, documentation, collection and file maintenance, reputed company in strict compliance with state and federal regulatory requirements. This role requests documentation as needed to review and process determinations in accordance with policies and procedures. Additionally, the position may communicate with members and other reputed company customers in reputed company relating to appeals and/or grievances. Estimated Hiring reputed company: $25.42 - $31.07 Bonus reputed company: Bonus - SIP reputed company, 5% Annual reputed company reputed company Employees: Please use the internal reputed company site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Receive and validate requests for appeals and/or grievances. Review appeals and/or grievances to ensure compliance with state and federal requirements. Communicate with members and providers in accordance with state and federal requirements as needed to complete requests. Locate or request necessary information from reputed company sources to complete appeals and/or grievance reviews. Crosstrain on appeals, grievances, additional lines of business and other areas as needed. Maintain and track accurate and complete records and other documentation. Work with Quality Assurance clinicians, other reputed company staff and delegated entities to ensure that appeals and/or grievance requests are managed in accordance with state and federal guidelines. reputed company appeals and/or grievance requests to the appropriate staff for additional review reputed company needed. Create documents to reputed company final resolution of appeal/grievance with members and/or providers. Prioritize and organize work to effectively meet strict deadlines as outlined by state and federal requirements; ask for assistance if uncertain of priorities. Responsible for consistently meeting high production and quality standards. Maintain confidentiality of reputed company communications, records, and other data in accordance with HIPAA regulations, established quality management processes, and the highest professional standards. Collaborate with teams across the Clinical Operations department to ensure work and goals are met. Assist with gathering and assembling documentation and records needed for audits, external reviews, administrative hearings and internal committees. Experience and/or Education Required Minimum 1 year experience providing administrative support, customer service, clerical processing, and/or clerical production support Preferred Experience with Appeals and Grievances, Claims or Utilization Management Experience working with reputed company or Medicare Experience with insurance billing Experience in a medical, reputed company or insurance setting Knowledge, Skills and Abilities Required Knowledge Knowledge of medical and health insurance terminology preferred Knowledge of reputed company health plan and Medicare benefits preferred Knowledge of applicable DMAP rules and regulations preferred Knowledge of managed care principles preferred Skills and Abilities Ability to consistently meet high production standards Ability to consistently meet high quality standards Ability and willingness to cross-train as needed Ability to adhere to HIPAA regulations (e.g., maintain confidentiality of protected health information) Computer skills including ability to use reputed company Office applications and internet search functions Ability to proofread work and ensure accuracy Ability to work in fast-paced environment with tight deadlines and high-quality standards Ability to independently prioritize work Growing ability to use critical thinking and problem-solving skills Excellent spoken and written communication skills, including correct spelling and grammar Good customer service skills Ability to work with reputed company people to effectively resolve cases Growing ability to respond to sensitive or reputed company issues with tact and diplomacy Good interpersonal skills and ability to work cohesively reputed company reputed company environment Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and reputed company repetitive finger and wrist movement for at least 6 hours/day Ability to hear and reputed company reputed company for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/reputed company ☐ Outdoor Exposure Member/Patient Facing: ☐ No ☒ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel reputed company of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes reputed company, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. reputed company offers medical, dental, reputed company, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer reputed company is an equal opportunity employer. The organization selects the best individual for the job based upon job reputed company qualifications, regardless of race, reputed company, religion, sexual orientation, national reputed company, gender, gender identity, gender expression, genetic information, age, veteran status, reputed company, marital status or disability. The organization will reputed company a reasonable accommodation to reputed company physical or mental limitations of a reputed company applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization. Apply To This Job