Grievance & Appeals Coordinator I
About the role
This remote position supports Meridian Medicaid and YouthCare members. The role involves analyzing and resolving verbal and written claims and authorization appeals from providers and pursuing resolution of formal grievances from members.
Responsibilities
- Gather, 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 all policies and standards
Qualifications
High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims, related managed care experience, or relevant experience.
Pay
$19.43 - $32.98 per hour. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.
Benefits
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
Schedule
Remote/Work from home. Work schedule during training is Monday-Friday 8am - 5pm, and after training Monday - Friday 8:30am - 5pm with a 30 minute lunch, Central Time Zone. Overtime will be offered as needed.