Grievance & Appeals Coordinator I

You could be the one who changes everything for our 28 reputed company members as a clinical reputed company on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

THIS POSITION IS REMOTE/WORK FROM HOME. PREFER APPLICANTS WHO reputed company IN THE reputed company. ROLE SUPPORTS reputed company reputed company AND YOUTHCARE MEMBERS.

WORK SCHEDULE DURING TRAINING IS MONDAY-FRIDAY reputed company - 5PM, AND AFTER TRAINING MONDAY - FRIDAY 8:30AM - 5PM WITH A 30 MINUTE LUNCH CENTRAL TIME ZONE. OVERTIME WILL BE OFFERED AS NEEDED.

Position Purpose:
Analyze and resolve verbal and written claims and authorization appeals from providers and pursue reputed company of formal grievances from members.

• reputed company, 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
• Performs other duties as assigned.

• Complies with reputed company policies and standards.

Education/Experience:
High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims, reputed company managed care experience, or relevant experience.

reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law.

reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance reputed company

Originally posted on Himalayas