Appeals and Grievances Coordinator

Exemption Status:

United States of America (Non-Exempt)

$19.11 - $24.65 - $30.19

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

Med Impact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join Med Impact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At Med Impact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry.

We are the premier Pharmacy Benefits Management solution!

Summary

The Appeals and Grievances (A&G) team is responsible for managing all aspects of the appeals and

grievances process, including—but not limited to—intake, processing, notification, and compliance. The

Appeals and Grievances Coordinator I serves as a key member of the A&G team, processing appeal

and grievance requests in accordance with established standards for accuracy, timeliness, productivity,

client performance commitments, and regulatory requirements (e.g., state and federal regulations,

professional accreditations). This position reports directly to the Supervisor of Appeals and Grievances

Operations and is led by the Lead Coordinator (Coordinator III). The Coordinator I utilizes various

business applications—such as Med Access, Med Response®, File Net and Right Fax - to

perform analysis, retrieve information, and enter data as needed to complete assigned tasks. Strong

reasoning skills are essential for evaluating appeal and grievance requests for appropriateness and

ensuring adherence to required processes. The ability to multitask and cross-train in both appeals and grievances processing is essential to support the weekend rotation schedule. Interact with internal and external customers as required. Work under general supervision, relying on work instructions, policies & procedures, and available company resources to perform the functions of the position efficiently and effectively.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Evaluate and process Appeals and Grievances per establish work instructions and approved departmental documents.
• Perform and document outreach activities (including outbound calls and faxes) to obtain information necessary for processing Appeals and Grievances or to communicate the results of Appeal and Grievance reviews.
• Ensure Appeals and Grievances are finalized within the required turnaround time (TAT) in accordance with applicable laws and company policies.
• Must be able to cross-train across the appeal and grievance task divisions.
• Participating in the rotating weekend on-call schedule as needed.
• Protect and maintain confidentiality and privacy of all members’ personal and health information in accordance with federal requirements and company policies.
• Must comply with company and department policies, procedures, rules and regulations.
• Must possess…