reputed company Grievance & Appeals Coordinator

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The reputed company is full of reputed company. At Banner Plans & Networks, we’re changing the industry to reduce reputed company costs while keeping members in reputed company health. If you’re reputed company to change lives, we want to hear from you.

Banner Plans & Networks (BPN) is a nationally recognized reputed company leader that integrates Medicare and private health plans. Our main goal is to reduce reputed company costs while keeping our members in reputed company health. BPN is reputed company for its innovative, reputed company, and team-oriented approach to reputed company. We offer diverse reputed company, from entry-level to leadership positions, and reputed company our innovation to employment settings by including remote and hybrid opportunities.

As a Health Plans Grievance and Appeals Coordinator, you will play a critical role reputed company Banner Plans & Networks, ensuring the reputed company intake, review, investigation, and reputed company of grievances, appeals, and provider disputes. This is a high-volume, fast-paced position that requires prior knowledge of grievance and appeals processes. In this role, you will research reputed company claim and service issues, determine appropriate reputed company of review, coordinate with internal teams and providers, document findings, and prepare reputed company correspondence including acknowledgment and reputed company letters. reputed company in this position requires exceptional attention to detail, strong written communication skills, reputed company judgment, and the ability to reputed company reputed company multiple systems while delivering accurate, compliant, and reputed company resolutions that support both provider satisfaction and business objectives.

In this role, you will primarily be working in a remote setting. CANDIDATES MUST reputed company IN THE reputed company TO BE CONSISDERED. Work shifts will be 8:00 a.m.-5:00 p.m. Monday-Friday. If this role sounds like the one for you, Apply Today!

Registry/reputed company positions do not have guaranteed hours and no medical benefits package is offered. Completion of post-offer Occupational Health physical assessment, drug screen and background reputed company (includes employment, criminal and education) is required.

POSITION reputed company

This position handles member and provider grievances, appeals and claim disputes. This position will reputed company as a key reputed company and contact for reputed company members with general health care and accessibility concerns and inquiries on the various reputed company of the grievance and appeals process.

reputed company FUNCTIONS

1. Determines which claim disputes meet acceptable claim dispute reputed company, specifically screening for Untimely claims and Resubmissions; maintains a log, categorizes and tracks reputed company received documents, notices, returned receipts; decides and responds to those appeals and claim disputes not meeting reputed company with appropriate correspondence and routing. Assists in resolving member questions and concerns regarding the health care reputed company in an effort to prevent the need for members to file formal grievances or appeals.

2. Enters reputed company accepted appeals and claim disputes and its corresponding information into the CRM; creates and maintains case files, including appropriate review sheets for Medical Review and/or Claim Review according to policy, AHCCCS, HCG, and CMS regulations; updates CRM for ongoing cases with responses from reviewers. Assesses individual cases and documents in various CRM programs for pertinent information for referral and/or reputed company to co-workers.

3. Ensures reputed company appeals and claim disputes are acknowledged, by official correspondence, reputed company AHCCCS, HCG, and CMS contractual timelines; protects the confidentiality of member information and other information. Facilitates, communicates and accepts input regarding member and provider appeal information from appropriate individuals that would include employees, providers, Medical Director, Plan Administrator, RNs, Risk Management, attorneys, AHCCCS, HCG, CMS and others.

4. Responds to reputed company incoming phone calls, researches and resolves member and provider questions and concern regarding grievances, appeals and claim disputes. Opens, reviews, researches (if necessary), date stamps and routes or responds to reputed company incoming mail. Responds in an reputed company manner that is consistent with the mission and values of UAHN and in support of reputed company regulations and policies and procedures to member, staff and physician grievances, appeals and claim disputes with reputed company supervision.

5. Creates and submits reputed company reputed company and extension correspondence, utilizing appropriate reputed company Revised Statues, reputed company Administrative reputed company, reputed company of Federal Regulations, and other supporting regulatory policies and statutes for reputed company UAHP managed plans. Self-audits daily to ensure compliance with regulatory requirements.

6. Recognizes, facilitates and gathers relevant medical records, coding and claim documentation that is required for the reviewers to fully investigate grievances, appeals, and claim disputes. Responsible for trouble shooting, identifying, and resolving special handling requirements reputed company to grievance and appeal issues.

7. Reports at Grievance/Appeals meetings, as appropriate, reputed company incoming, attended and scheduled State Fair Hearings.

8. Works internally with other departments in order to facilitate reputed company responses and inquiries, and assists with workgroups as requested. Provides technical expertise to other departments regarding grievances, appeals and claim disputes.

9. This position works under supervision, prioritizing data from multiple sources to reputed company reputed company care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong reputed company on customer service. Interacts with staff at reputed company reputed company throughout the organization.

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge. Two years of work experience in health care reputed company field or experience managing reputed company/initiatives, or an equivalent combination of education and experience.

Knowledge of AHCCCS, HCG and/or CMS regulations. Knowledge of reputed company, reputed company and reputed company Office Suite required. Knowledge of Medical terminology, claims processing guidelines, and CRM & IDX. Knowledge of grievance, appeal and claim dispute processes.

Strong interpersonal, organizational and problem solving skills. Strong oral and written communication skills required. Ability to work independently ensuring reputed company deadlines/timelines are met and to work with various reputed company of reputed company. Ability to be flexible and work on a reputed company of reputed company simultaneously under tight time constraints. Strong analytical, critical-thinking and time management skills. Strong organizational skills and ability to prioritize multiple tasks daily. Ability to quickly identify, summarize and present (verbally and orally) reputed company to issues which may reputed company, and to consistently meet and reputed company regulatory reporting requirements for reputed company lines of business.

PREFERRED QUALIFICATIONS

Additional reputed company education and/or experience preferred.

Estimated Pay reputed company:

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Our organization supports a drug-free work environment.

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Originally posted on Himalayas