Appeal and Grievance Coordinator

SGS_JOB_1650

Business Support
Remote
Appeals& Grievance
Medicaid
Medicare

Contract - 4 months + (Contract to Hire)

Small Description: As an Appeal and Grievance Coordinator, you will receive, investigate and triage expedited appeal requests received from members/member and provider representatives enrolled in Senior Products. Timely assignment of cases is critical to ensure member's and/or provider's appeal rights are processed in accordance with regulatory agencies' standards, including the Center for Medicare and Medicaid Services.

Job Responsibilities:

  • Claims research and processing (more of researching why the claim was denied than researching into the claim)
  • Authorization lookup/ building authorizations as well as updating authorizations
  • Researching outside vendor sites for authorizations and reviewing notes -Reviewing appeal letters to determine what the provider is appealing -Responsible for starting the appeal process and researching the appeal. Responsible for sending out appeal determination letters and completing the appeal.
  • Extensive training on internal and external systems and the internal appeal process

Skills:

  • Appeals& Grievance, Medicaid, Medicare

Education/Experience:

  • At least 1 year of experience in health insurance claims and appeals is strongly preferred.
  • At least a HS degree, but a college degree and/or extensive experience would be considered.
  • Outbound call experience (though not a large part of this job) is a good to have.
  • A customer service background and experience, not necessarily in the healthcare field, is a nice to have as well.
  • Medicaid experience is desired and will make the candidate stand out.

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