Appeal & Grievance Coordinator

Appeal & Grievance Coordinator
Wheeling, WV
Full-Time
Finance - Quality Management
Supervisor

Responsible for the research, coordination, and documentation of written and verbal grievances/appeals filed by members/providers. 

This includes the beginning-to-end process in accordance with the standards and requirements established by various regulators. 

Examples include but are not limited to:  CMS, BMS, DOI, NCQA and EQRO. 

  1. High school diploma; college preferred;
  2. Detail oriented;
  3. Excellent customer services skills;
  4. Ability to work independently and as part of a team;
  5. Excellent time management skills with the ability to meet regulatory guidelines;
  6. Proficient in Microsoft Office products;
  7. Ability to review, understand and apply the provisions of policies and procedures.

  1. Knowledge of managed care state and federal guidelines and regulations;
  2. Previous experience in managed care setting;
  3. Familiar with medical terminology, ICD 10 and CPT coding.

Employment Documents

EEO

Or, if you are interested in a fast-paced career with us, please send resume with salary requirements to:

HR Department 
1110 Main Street
Wheeling, WV 26003-2704
hr@healthplan.org