Grievance and Appeals Coordinator-Remote Job at HireOps Staffing, LLC
Title: Grievance and Appeals Coordinator I
Shift: 8:3AM-5:00PM CST
Location: Remote IL- Work from home but must reside in IL
Target start date: 5/21/23. Training is approximately 1 month.
Summary:
Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
Job Responsibilities:
- Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
- Prepare response letters for member and provider complaints, grievances and appeals
- Maintain files on individual appeals and grievances
- May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
- Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research.
- Manage large volumes of documents including copying, faxing and scanning incoming mail
Education/Experience:
- High school diploma or equivalent.
- Associate’s degree preferred.
- 2+ years grievance or appeals, claims or related managed care experience.
- Strong oral, written, and problem solving skills
- Word, Excel, Outlook required
What previous job titles or background work well in this role?
- Appeals and grievance.
- Medicaid experience.
- Managed Care experience.
- Claims experience
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