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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
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1+ year of healthcare experience - preferably in grievance, appeals, claims or denials but call center from MCO background would work too
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Data entry skills
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Proficiency in Excel
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HS Diploma or GED
Soft Skills Required:
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Good written communication skills
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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:
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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);
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Gathering all pertinent and relevant information regarding the grievance/appeal, determining the appropriate resolution of the grievance/appeal per standard policies and procedures; and
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Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue.
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Conducts non-biased, accurate, timely and comprehensive investigation of all the facts related to the grievance/appeal.
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Thoroughly documents all action taken on behalf to resolve the grievance/appeal.
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Ensures that all grievances/appeals are processed in adherence to state and federal regulations, contractual obligations, NCQA guidelines and Plan policy.
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Prepares clear, objective, accurate and comprehensive case histories.
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Maintains accurate and timely documentation, including complete files of all grievances/appeals.
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Non-Exempt - Reporting to work on time and for all scheduled shifts is essential to this position.
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Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
