Appeal and Grievance Coordinator [Remote]

Job Responsibilities:

• Claims research and processing (more of researching why the claim was denied than researching into the claim)
• Authorization lookup/ building authorizations as well as updating authorizations
• Researching outside vendor sites for authorizations and reviewing notes -Reviewing appeal letters to determine what the provider is appealing -Responsible for starting the appeal process and researching the appeal. Responsible for sending out appeal determination letters and completing the appeal.
• Extensive training on internal and external systems and the internal appeal process

Skills:

• Appeals& Grievance, Medicaid, Medicare

Education/Experience:

• At least 1 year of experience in health insurance claims and appeals is strongly preferred.
• At least a HS degree, but a college degree and/or extensive experience would be considered.
• Outbound call experience (though not a large part of this job) is a good to have.
• A customer service background and experience, not necessarily in the healthcare field, is a nice to have as well.
• Medicaid experience is desired and will make the candidate stand out.