Lead Grievance & Appeals Coordinator

THIS POSITION IS REMOTE/WORK FROM HOME SUPPORTING OUR ILLINOIS HEALTH PLAN MEDICAID AND YOUTHCARE GRIEVANCE & APPEALS PROCESSING TEAM.

Schedule

The work schedule is Monday - Friday 8AM - 5PM Central Time Zone with over-time as needed during the week and approximately every other weekend for some on-call duties.

Responsibilities

• Maintain a smaller caseload
• Provide updates on status of daily case completion by assigned team members
• Error management
• Run daily huddles
• Contribute to job aids, Q&As, and support process changes
• Coach staff
• Support state fair hearing process as needed
• Provide support and direction for the daily operations of the appeals function
• Provide consultation for problem resolution for appeals staff and monitor team work output to ensure compliance with internal and NCQA standards
• Identify training, process improvement, and resource needs to maximize team performance and recommend action plans to management
• Review denial and appeal letters as needed to ensure appropriate content and message
• Prepare for state/health plan audits, response to complaints, and request for state fair hearing documentation
• Prepare monthly reports, logs, and other health plan or state contractual requirements
• Review and monitor team workload and output to ensure optimum efficiency and accuracy
• Serve as the point of contact for issues that arise from members, providers, and internal team
• Train and educate new and existing team on processes, policies and procedures, and contract or market requirements
• Perform other duties as assigned
• Comply with all policies and standards

Requirements

• Bachelor’s degree in related field or equivalent experience
• 2+ years of grievance and appeals experience in a Healthcare or Managed Care setting

Pay

Pay Range: $23.23 - $39.61 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

Benefits may be subject to program eligibility.