Grievance & Appeals Coordinator

Immediate need for a talented Grievance & Appeals Coordinator. This is a 03+months contract opportunity with long-term potential and is located in Nashville, TN(Remote). Please review the job description below and contact me ASAP if you are interested.
 
Job ID:24-48724
 
Pay Range:$21 - $22/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Responsibilities:

• Grievance Coordinator is responsible for corresponding with members, providers and regulators regarding decisions and actions.
• Works collaboratively with the Claims, Customer Service, Appeals, and Medical Management Departments.
• Communicate, collaborate and cooperates with internal and external business partners.
• Adheres to all Compliance/Program Integrity requirements and complies with HIPAA Regulations.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
• Supports department-based goals which contribute to the success of the organization

Key Requirements and Technology Experience:

• Key Skills: Grievance & Appeals, Health Insurance, Medicare or Medicaid.
• Written communication 
• Critical Thinking 
• Microsoft Office Knowledge 
• Minimium requirement: 1 year of G&A and/or 1+ year or more of Customer Service at a health insurance company
• Bilingual in Spanish is preferred but not required
• Strong written and verbal communication skills, PC proficiency to include Microsoft office products.
• One year of health insurance/managed care experience performing Appeals and Grievances functions.
• Will consider managed care associates with three years of experience in customer service, call center or claims processing skills and knowledge of healthcare delivery.
• Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment.
• Demonstrated written communication skills, time management, priority setting, problem solving and organizational skills.
• Demonstrated ability to converse with and collaborate with physicians and physician personnel.
• Ability to identify and define problems, collect data/information, establish facts, and draw valid conclusions and provide resolution.
• Ability to track and manage case load effectively in Grievance tracking system
• Must be able to work independently and under pressure related to tight time-frames
• One year of health insurance/managed care experience knowledge of healthcare terminology preferable.
• Intermediate PC Skills
• Previous experience working in a remote setting is preferred
• A high school diploma and two years in a Medicare, Medicaid managed care environment investigating and resolving Grievances

Our client is a leading Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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