Grievance appeals coordinator i

Job Description Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Education/Experience: High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims or related managed care experience. oral, written, and problem solving skills. • Gather, analyze and report verbal and written member and provider complaints, grievances and appeals • Prepare response letters for member and provider complaints, grievances and appeals • Maintain files on individual appeals and grievances • May coordinate the Grievance and Appeals Committee • Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information • Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research. • Manage large volumes of documents including copying, faxing and scanning incoming mail Typical Day in the Role Organize caseload based on due dates, complete case documentation in system, make outbound calls and sent written communication. Candidate Requirements Years of experience required: preferred:2+ years grievance or appeals, claims or related managed care experience. oral, written, and problem solving skills. Top 3 must-have hard skills stack-ranked by importance 1Knowledge about Iowa Medicaid Program and Services 2 Previous call center experience helpful


salary: $18.44 - $18.45 per hour
shift: First
work hours: 8:30 AM - 4 PM
education: High School

Responsibilities

• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research.
• Manage large volumes of documents including copying, faxing and scanning incoming mail

Skills

• Problem Solving
• Analyze and resolve
• verbal and written claims

Qualifications

• Years of experience: 1 year
• Experience level: Experienced

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on click.appcast.io.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.