Grievance & Appeals Coordinator I
Core
Analyze and resolve verbal and written claims, authorization appeals, and formal grievances from providers and members.
Role type
Claims and appeals coordinator
Builds
Member and provider complaint resolution workflows
Domain
Healthcare / Managed care
Deliverable
dashboards & analysis
Required skills
Claims research, data entry, document management, claims analysis, grievance processing, appeals processing
Preferred skills
Mail-order experience, HEDIS production support
Responsibilities
Gather and report member and provider complaints, grievances, and appeals; Prepare response letters for complaints and appeals; Maintain files on individual appeals and grievances; Coordinate the Grievance and Appeals Committee; Support pay-for-performance programs with data entry and tracking; Assist with HEDIS production functions including data entry and claims research; Manage large volumes of documents including copying, faxing, and scanning.