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Appeals And Grievance Coordinator Jobs

Appeals And Grievances Coordinator
By Clear Spring Health At Miramar, FL, United States

Candidates should have working knowledge of Medicare and member services or work in a health plan or health plan supprting vendor.

Appeals Coordinator Jobs
By W3R Consulting At Detroit, MI, United States
Preferred Skills/Experience Previous health care or health insurance industry experience
Education/Certifications Bachelor’s Degree in English, Communication, Health Care Administration, or related field
Job Title: Appeals Coordinator- 100% remote
•Excellent written and verbal communication skills. Must be proficient in proofreading, spelling, grammar, punctuation, and math
•Previous customer service or concierge experience
•Strong PC application and system skills- having the ability to navigate multiple computer systems and databases
Grievance And Appeals Coordinator - Remote | Wfh
By Get It Recruit - Healthcare At Sacramento, CA, United States

Are you a skilled communicator and problem solver with a knack for clear, concise writing? We're seeking a dedicated Member Support Specialist to join our team. As a crucial link between our members ...

Grievance & Appeals Quality Assurance Specialist
By SnugZ USA At New York, NY, United States
3 years quality management experience
Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.
Update current workflows and draft future workflows, incorporating regulatory requirements, quality, and efficiency within design.
Auditing, researching, analyzing and evaluating grievance and appeals data to assess compliancy between process and the corresponding CMS and DOH regulations.
Coordinate, facilitate and document audit walkthroughs.
Develop training and refresher training.
Appeals & Grievance - Rn
By Yamhill Community Care At , Mcminnville
Knowledge of Managed Care / Medicaid requirements.
Maintains confidentiality of all discussions, records, and other data in connection with quality management activities according to professional standards.
Any combination of education and experience that would qualify candidate for the position.
Health care benefit and regulatory knowledge.
Knowledge of Oregon Medicaid grievance system requirements.
Ensures resolutions are compliant and meets turnaround times requirements dictated by policies and procedures.
Appeals Coordinator Level I
By MedReview Inc. At New York, NY, United States
Manage large volume of documents including faxing, downloading, and uploading from different databases or SFTP
Knowledge of organization of medical records and medical claims terminology preferred
Strong analytical skills with the ability to make timely and sound decisions to meet department standards
Good interpersonal and written/oral communications skills
Performs accurate categorization and appropriate triage upon receipt of each appeal or inquiry
Assures timelines and appropriateness of appeals
Grievance & Appeals Specialist- Remote
By EmblemHealth At New York, NY, United States
Relevant Work Experience, Knowledge, Skills, And Abilities
Additional years of experience/training may be considered in lieu of educational requirements. (R)
Excellent organization and time management skills. (R)
Experience in a managed care/compliance environment. (P)
Determine eligibility, benefits, and prior activity related to the claims, payment or service in question.
3+ years of related professional work experience. (R)
Grievance/Appeals Analyst I (Us)
By Elevance Health At California, United States
Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
12898 Towne Center Drive, Cerritos, CA
3080 Bristol Street, Costa Mesa, CA
11030 White Rock Road, Rancho Cordova, CA
1121 L St., Suite 500, Sacramento, CA
2121 N. California Boulevard, Walnut Creek, CA
Appeals And Grievances Lead
By Gold Kidney Health Plan At United States
· Exceptional time management skills.
· Promote a provider-friendly, customer service-oriented philosophy within the Fresenius Health Partners Utilization Management department.
· Strong computer skills with demonstrated proficiency in word processing, spreadsheet, database, presentation and email applications.
· 2 – 4 years’ related experience required
· Medicare Advantage Appeals and Grievance experience required.
· Excellent analytical and leadership skills.
Quality Assurance Specialist, Appeals & Grievance
By Alignment Health At California, United States
Produces departmental quality performance reports for management review.
2+ years of managed healthcare experience.
Knowledge of Medicare Managed Care Plans required.
Possess the knowledge of Appeals and Grievance procedures and the Centers for Medicare (CMS) regulatory compliance guidelines.
Analyzes and validates accuracy of Appeals and Grievance data according to plan business and CMS regulatory technical reporting requirements.
2+ years healthcare appeals & grievances experience, related QA experience, or training/supervisory role.
Appeals Coordinator Jobs
By Anthem Blue Cross and Blue Shield At Norfolk, VA, United States

Experience in a behavioral health setting, managed care experience preferred, UM experience also preferred.

Appeals Coordinator Jobs
By Brighton Health Plan Solutions At United States
• Maintain broad knowledge of client products and services
• Strong knowledge of contracts, medical terminology, and claims processing and procedures
• 1+ year computer medical billing or claims adjudication systems experience
• Previous experience handling appeals and grievances
• High School Diploma or GED diploma; some college or business school education is a plus
Company: Brighton Health Plan Solutions
Appeals Coordinator Jobs
By Select Source International At Durham, NC, United States
Demonstrates high degree of appropriate knowledge of all areas of the plan.
Identify and create action plans to educate internal departments on benefit misinterpretation and/or claim payment system errors.
Audit and oversight of entities where delegation of member and provider appeals exists.
Answer member/provider questions via incoming telephone calls in a professional quality driven manner.
May handle complaints/grievances as defined by the federal government.
Appeals And Grievance Coordinator
By BroadPath At United States
2+ years of Medicare Appeals/Grievance experience required
Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
Excellent verbal and written communication skills
However, based on performance BroadPath can offer other opportunities based on availability once the contract ends.
Processing Medicare Appeals/Grievance with Medicare Part C or D experience
Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue
Appeals Coordinator - Need Icd-10 Certification
By TalentBridge At Pittsford, NY, United States
Performing other duties as assigned by management
Associate's Degree from an accredited college or university or equivalent experience
At least two (2) years of experience in a medical billing, claims processing, or related position required
Job Duties Include, But Are Not Limited To
Minimum Qualifications for the position:
Review and analyze case file materials that involve claims payment disputes
Member Grievance & Appeals Liaison
By Commercial Solutions At , , Az
Utilize multiple systems to investigate escalated inquiries on Members and follow the member experience from beginning to resolution
Manage resolution of activities in CRM, including HICS from CMS according to defined turnaround times
Collaborate with internal teams and external partners to resolve complaints and document issue and resolution in CRM
Conduct member outreach based on a variety of trends such as frequent caller data and out of network claim denials
Recommend workflows and policy as a result of Member feedback and escalation data analysis
Document appropriate client specific information in CRM
Customer Service And Appeals Supervisor
By MagnaCare At United States
Assist the Operations Manager with performance reports, QA review sessions and re-training initiatives.
Escalate workflow and processing issues for Customer Service and Appeals to Operations Manager.
Manages departmental call activity and ensures appropriate staffing levels and scheduling to meet department goals.
Conducts quality call monitoring review sessions with the Operations Manager to coach performance and identifies additional training needs.
Works with Operations Manager to identify call reduction efforts and executes strategies accordingly.
Support projects when directed by Operations Manager.
Manager Of Grievance And Appeals
By Delta Dental Ins. At , Alpharetta, Ga
Excellent organizational and time management skills, with the ability to multi-task while maintaining attention to detail.
8+ years w/Bachelor's degree; 1+ years supervisory/management
Minimum 5 years' experience in health insurance, with 3 years' experience in grievance and appeals and/or healthcare regulation and law
Strong critical thinking and analytical skills.
Strong interpersonal, written, and verbal communication skills.
Intermediate knowledge of Microsoft Office programs, i.e. Word, Excel, Outlook etc.
Manager, Grievance And Appeals
By CareSource At , Remote $76,700 - $122,700 a year
Minimum of three (3) years of management experience is preferred
Basic experience with Call Management Systems
Strong interpersonal skills, high level of professionalism and a collaborative management style
Manage staff to ensure timely and accurate completion of tasks and issues are accomplished
Oversee and monitor processes to ensure department is meeting all regulatory requirements and accreditation standards
Review and interpret regulatory requirements and ensure business policies and processes are in compliance
Grievances And Appeals Specialist
By Papa At United States
Ability to work under pressure and within time constraints – excellent time management and prioritization skills are needed.
Intake and management of complex complaints from senior citizens from multiple categories including safety.
Coordinates additional follow up outreach as needed to conclude an investigation and will ensure appropriate departmental communication with managers.
Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness, and other skills as identified.
Strong written and verbal communication skills and an ability to work with people from diverse backgrounds displaying compassion, empathy and understanding.
1 year of Grievance and appeals experienced preferred

Are you looking for an exciting opportunity to make a difference in the lives of others? We are seeking an experienced Appeals and Grievance Coordinator to join our team! In this role, you will be responsible for managing the appeals and grievance process for our organization. You will be responsible for ensuring that all appeals and grievances are handled in a timely and efficient manner. You will also be responsible for providing guidance and support to staff and clients throughout the process. If you have excellent communication and problem-solving skills, and a passion for helping others, then this may be the perfect job for you!

Overview An Appeals and Grievance Coordinator is responsible for managing the appeals and grievances process for an organization. This includes responding to appeals and grievances from employees, customers, and other stakeholders, and ensuring that the organization’s policies and procedures are followed. The Appeals and Grievance Coordinator must be knowledgeable of the organization’s policies and procedures and be able to effectively communicate with all stakeholders. Detailed Job Description The Appeals and Grievance Coordinator is responsible for managing the appeals and grievances process for an organization. This includes responding to appeals and grievances from employees, customers, and other stakeholders, and ensuring that the organization’s policies and procedures are followed. The Appeals and Grievance Coordinator must be knowledgeable of the organization’s policies and procedures and be able to effectively communicate with all stakeholders.

The Appeals and Grievance Coordinator is responsible for:

• Responding to appeals and grievances in a timely and professional manner
• Investigating appeals and grievances to determine the facts and the best course of action
• Documenting all appeals and grievances
• Developing and implementing procedures for appeals and grievances
• Ensuring that the organization’s policies and procedures are followed
• Communicating with all stakeholders involved in the appeals and grievances process
• Providing guidance and support to employees and customers
• Resolving appeals and grievances in a fair and equitable manner
• Keeping up to date on changes to the organization’s policies and procedures
• Maintaining records of appeals and grievances
• Reporting on appeals and grievances to management
Job Skills Required
• Excellent communication skills
• Ability to investigate and analyze information
• Knowledge of the organization’s policies and procedures
• Ability to work independently and as part of a team
• Ability to manage multiple tasks and prioritize work
• Excellent problem-solving skills
• Ability to remain calm and professional in difficult situations
Job Qualifications
• Bachelor’s degree in Human Resources, Business Administration, or a related field
• At least two years of experience in a customer service or human resources role
• Knowledge of appeals and grievances processes
• Experience with conflict resolution
• Knowledge of relevant laws and regulations
Job Knowledge
• Knowledge of the organization’s policies and procedures
• Knowledge of appeals