HealthCare Support Staffing

New Job!   HCS Job Title: Grievance & Appeals Coordinator Company Job Title: Grievance & Appeals Coordinator I Working with TA Jordan Smith Vaccination NOT REQUIRED  # of Openings:  2 If Contract, Length of Assignment:  3 months MU or BR:  60% MU Compensation Notes:  $22 to $22 an hour Location:  Remote in WA Shift: M-F 8-5 Start Date: ASAP Interview Times/Interviewer: Virtual with HM Minimum Education/Licensures/Qualifications: Must include city and state on resume

• 1+ year of healthcare experience - preferably in grievance, appeals, claims or denials but call center from MCO background would work too
• Data entry skills
• Proficiency in Excel
• HS Diploma or GED

Soft Skills Required:

• Good written communication skills
• Ability to work independently, please specify if any positions on resume were remote

Types of Candidates to Submit to Sales Rep: Best Candidate: Grievance and Appeals Coordinator with 2+ years of recent experience from MCO setting Second Best Candidate: Denials or Claims Specialist with 2+ years of recent experience from MCO setting Third Best Candidate:  CSR/MSR with 2+ years of recent experience from MCO setting Day to Day Duties: The focus for the position will be solely on post payment appeals, not member appeals. Provides basic grievance and appeals guidance and support to a limited number of providers. Resolve grievances and appeals, which includes:

• Sending the appropriate acknowledgement of the grievance/appeal; Providing education about the grievance/appeal process and the right to appeal to state or federal agencies (if applicable);
• Gathering all pertinent and relevant information regarding the grievance/appeal, determining the appropriate resolution of the grievance/appeal per standard policies and procedures; and
• Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue.
• Conducts non-biased, accurate, timely and comprehensive investigation of all the facts related to the grievance/appeal.
• Thoroughly documents all action taken on behalf to resolve the grievance/appeal.
• Ensures that all grievances/appeals are processed in adherence to state and federal regulations, contractual obligations, NCQA guidelines and Plan policy.
• Prepares clear, objective, accurate and comprehensive case histories.
• Maintains accurate and timely documentation, including complete files of all grievances/appeals.
• Non-Exempt - Reporting to work on time and for all scheduled shifts is essential to this position.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.