Grievance & Appeals Coordinator

Base pay range

$22.00/hr - $22.50/hr

Immediate need for a talented Grievance & Appeals Coordinator I. This is a 03+ Months Contract opportunity with long-term potential and is located in GA (Remote). Please review the job description below and contact me ASAP if you are interested.

Job
-81598

Pay Range: $22 - $22.50/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

• The workday is spent acknowledging and resolving member appeals within established turnaround times. Member facing team but providers may reach out to request appeals on members behalf.
• Appeals mainly via fax but may come through phone or email
• Maintain or exceed 98% compliance rate for all appeal files while meeting daily productivity benchmark of 8-10 cases per day based on the volume.
• This role ensures regulatory compliance by managing time-sensitive member appeals in accordance with CMS and state guidelines.
• It requires deep knowledge of managed care processes, strong analytical and communication skills, and the ability to coordinate across departments to resolve complex issues impacting member care and health plan operations.

• Formal written communication; accuracy with data entry and tracking/ independent work.
• Prioritization and time management skills.
• Regulatory knowledge (CMS, Medicaid, NCQA).
• High school diploma or equivalent.
• At least 1+ years’ experience with Grievance & Appeals. Regulatory knowledge (CMS, Medicaid, NCQA).
• Previous grievance and appeals or UM prior authorization experience, regulatory knowledge, critical thinking/problem solving with independent work, organizational skills, adaptability, and professionalism.
• This is a production environment. Interpersonal skills. Technology proficiency.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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• Seniority level:
  Not Applicable
• Employment type:
  
  Contract
• Job function:
  Health Care Provider
• Industries:
  Hospitals and Health Care