Appeals And Grievance Coordinator

*Disclosure this is a 3 month temporary contract*

However, based on performance BroadPath can offer other opportunities based on availability once the contract ends.

The Appeals and Grievance Coordinator will be responsible for managing, coordinating, and resolving member and provider complaints, grievances, and appeals, ensuring compliance with state and federal regulatory requirements. Our Appeals and Grievance Coordinator will act as the primary investigator and contact person for the member and provider and perform research, resolution, and response to complaints on behalf of a member.

Responsibilities

• Thoroughly documents all action taken on behalf of the member or provider to resolve the grievance/appeal.
• Conducts non-biased, accurate, timely, and comprehensive investigation of all the facts related to the grievance/appeal
• Ensures that all grievances/appeals are processed in adherence to state and federal regulations
• Gathering all relevant information from the member or provider regarding the grievance/appeal and determining the appropriate resolution of the grievance/appeal per standard policies and procedures.
• Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue
• Sending appropriate acknowledgment of the grievance/appeal; educating the member or provider about the grievance/appeal process and their right to appeal to state or federal agencies (if applicable)

Basic Qualification

• High school diploma or equivalent
• Excellent verbal and written communication skills
• Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
• Ability to remain focused and productive each day though tasks may be repetitive
• VAM system experience required
• 2+ years of Medicare Appeals/Grievance experience required
• Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications

Preferred Qualifications

Processing Medicare Appeals/Grievance with Medicare Part C or D experience