Grievance & Appeals Coordinator
$22 - $23 per hourPyramid Consulting, Inc
Immediate need for a Grievance & Appeals Coordinator . This is a 12+ Month Contract opportunity with long-term potential and is US ( Remote ). Please review the job description below and contact me ASAP if you are interested. Job Diva ID: 26-07046 Pay Range: $22.00 - $23.00/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 Review, process, and resolve member appeals and grievance cases in accordance with company policies and regulatory requirements Ensure accurate documentation and case tracking while meeting quality and compliance standards Communicate with internal teams to gather required information and support case resolution Maintain clear and professional communication throughout the case management process Identify opportunities to improve processes and contribute to continuous improvement initiatives Ensure cases are handled within required timelines while maintaining high accuracy Support team collaboration to improve operational efficiency and customer satisfaction Key Requirements and Technology Experience Key skills: 2-3 years of experience in appeals and grievance, Healthcare administration, Health insurance operations, and Customer service within a regulated environment Strong attention to detail and ability to maintain accuracy when reviewing case documentation Knowledge of healthcare regulations or compliance requirements Familiarity with Medicare or Medicaid guidelines Strong communication and collaboration skills Analytical thinking and problem-solving ability Comfortable using standard office tools such as Microsoft Word, Excel, Outlook, Teams, and OneDrive Experience handling complex or compliance-related cases Strong written communication and letter-writing skills Experience coordinating projects or working with cross-functional teams in a fast-paced environment High School Diploma or equivalent Our client is a leading Healthcare 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. Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. #J-18808-Ljbffr Pyramid Consulting, Inc
$19.43 - $32.98 per hour
...report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints... ...appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-...SuggestedHourly payFull timePart timeLive inWork at officeRemote workFlexible hours- Harbor Health seeks an experienced Appeals & Grievances Director to lead the health plan's appeals and grievances function across Texas markets, ensuring CMS/TDI/NCQA compliance and timely resolutions. You will manage a team, collaborate with Compliance, Legal, Claims,...Suggested
- Harbor Health is seeking an experienced Appeals & Grievances Director to lead the health plan's appeals and grievances function. In this role... ...Medical Directors on clinical appeal reviews, including coordination of peer-to-peer and independent review organization (IRO) referrals...Suggested
- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...SuggestedRemote work
$30 - $35 per hour
...Now Hiring: Grievance & Appeals Specialists Are you an experienced Grievance & Appeals professional with a background in Medicare or Medicaid Managed Care? We're partnering with a leading healthcare organization that's looking to add multiple specialists to their growing...SuggestedWork at officeImmediate start- ...to handle department correspondence, log and route mail, and provide back-up support to coordinators and the director. The role emphasizes timely processing of grievances and appeals within regulatory timeframes. Responsibilities include opening and date-stamping mail,...
- Santa Barbara Cottage Hospital is seeking a Grievance and Appeals Nurse for a remote position based in Indiana. Responsibilities include investigating complex grievances and appeals, reviewing medical records for necessity, and preparing recommendations for Medical Director...Remote job
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote role at Healthfirst . Position Summary: The Appeals & Grievances (A&G) unit...Remote jobFull timeMonday to FridayShift work$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G works in collaboration...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work$22 per hour
Overview The Prior Authorization Coordinator will facilitate the logging in and out of all prior authorization, appeal, reimbursement and grievance requests, and follow-up on requests to ensure that all are resolved and completed in a timely manner. The coordinator will...Hourly payTemporary work$71.59k - $116.48k
A prominent healthcare organization is seeking an A&G Clinical Specialist to manage health member complaints and appeals. This fully remote position requires expertise in clinical case management, understanding of regulatory compliance, and the ability to effectively resolve...Remote job- ...providers where necessary. Verify medical benefits and facilitate the prior authorization process for company products. Coordinate the pre-service appeals process, including composition of appeals. Establish strong relationships with referring rheumatology practices,...Remote work
$50k - $52.1k
...fades and inserting correct digital markers that sound the most appealing based on music/content selection and channel genre Loads... ...schedule and archive Artist IDs and Interviews Assists with the coordination of music projects by compiling research data, and learns how...Temporary workLocal areaShift work$17.5 - $18.5 per hour
...together towards our shared purpose. Job Summary The Practice Coordinator is responsible for managing the front office daily activities... ...patient chart is prepared. General office duties, cleanliness, and appeal, such as sorting office mail, scanning documents, e‑faxes,...Full timeTemporary workWork at officeLocal areaRemote work$20 - $30 per hour
...collaborating in advance with the primary treating clinicians. Coordinate Peer-to-Peer (P2P) Review preparation and assist with scheduling... ...Authorization Required (NAR) requests. Establish post denial appeal response recommendations. Obtain portal access to any utilization...Remote work- Staffing Coordinator-Full Time page is loaded## Staffing Coordinator-Full Timelocations: Remote - Pennsylvaniatime type: Full timeposted... ...in which work will be accomplished.• Review complaints and grievances pertinent to scheduling and staffing. Make necessary oral/written...Full timeWork at officeImmediate startRemote work
- ...Denials Management Specialist to join our remote team. This role focuses on inpatient CMS denials, medical necessity reviews, and appeals for insurance payers. You will collaborate with Case Management and Billing to improve denial workflows and maximize timely reimbursements...Remote work
$50k
...DRG Validation, Cost Outlier and Readmission reviews. The Appeals Specialist I is responsible for performing triage, review, analysis... ...Provide clear, thorough, and accurate appeal responses ~ Coordinate and communicate with Clinical Review teams when new clinical...Contract workWork experience placementRemote work- ...Coastal Harbor Health is currently seeking a Utilization Review Coordinator Per Diem to coordinate and direct utilization review functions... ...review process for the purpose of preparing and submitting appeals to third‑party payors. Respect the confidentiality of patient...Daily paidTemporary workReliefLocal area
- ...include, but are not limited to the following: Ensure unit staff has all systems needed to process Primary Residence Verification appeals for the Non-Primary Residence Surcharge and liaise with other units in the DOF, to mitigate any issues that arise. Communicate and...Permanent employmentFull timeWork at officeRemote work2 days per week
$132.02k - $156.77k
About This Role The Transplant Coordinator, Registered Nurse- Heart Transplant is a vital member of the multidisciplinary Heart Failure/... ...paperwork Complete paperwork for prior authorizations, denials/appeals Prepare information for peer to peer authorizations Monitor...Full timeDay shift$23.51 - $29.38 per hour
The Center Coordinator, Family Business & Operations provides administrative, financial, and digital engagement support for the LMU Family... ...'s Statement of Non-Discrimination policy and related grievance procedures, click here. To report questions or concerns about...Part timeFixed term contractWork at officeLocal area$19 per hour
The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related... ...to processing Utilization Management prior authorization and appeals. JOB RESPONSIBILITIES Monitor incoming faxes Enter UM authorizations...Temporary workLocal areaRemote work$68k - $75k
Contracts Coordinator NY Executive & Contract Department Based in New York, NY Who We Are As the collective voice of more than 19,000 members... ...them If necessary, pursuing violations through the contract grievance process, working with colleagues in Los Angeles to ensure...Contract workWork at officeFlexible hours- ...people right, listening to new ideas and keeping culture at the heart of our business. about the role The Engagement Coordinator (EC)/Office Administrator (OA) at True Search will act as a vital team member supporting Partners and Principals in search...Full timeWork at officeLocal areaFlexible hours3 days per week
- ...environment. Key Responsibilities Perform insurance follow-up activities, including claim submission, claim status inquiries, and filing appeals for denied claims Process a high volume of detailed account information accurately and within established performance guidelines...Full timeWork at office
$75.2k
...New York health care consumers and small businesses. It also coordinates the Health Care for All New York Campaign (HCFANY), a coalition... ...coverage, how to access health care through a health plan, how to appeal a denial of coverage or care, how to access low-cost or free...Temporary workLocal areaRemote work2 days per week3 days per week$100.15k - $145.87k
...Jersey, seeks an attorney to act as Deputy Statewide Ethics Coordinator in the District Ethics Committee Unit within the OAE. This position... ...the Statewide Coordinator. Ensure the timely processing of grievances through tracking and follow up with District Secretaries...Work at officeRemote work$108k - $153k
DescriptionJob Title - Transplant Coordinator (NP/PA), Respiratory Institute-Mount Sinai Hospital-Full Time DayThe Transplant Coordinator is a Registered Professional Nurse, Nurse Practitioner or Physician Assistant with specific knowledge and skills who participates in...Full timeTraineeshipLocal areaWeekend work$23.58 - $47.94 per hour
Job DescriptionPosition Summary:The Legal Coordinator will provide a variety of administrative and project services supporting the intellectual property portfolio of the beer, wine, and spirits divisions, under the supervision of the VP, Deputy General Counsel and Manager...Minimum wageFull timeContract workWork at officeRemote workShift workNight shift
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