Appeal & Grievance Coordinator
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.
- High school diploma; college preferred;
- Detail oriented;
- Excellent customer services skills;
- Ability to work independently and as part of a team;
- Excellent time management skills with the ability to meet regulatory guidelines;
- Proficient in Microsoft Office products;
- Ability to review, understand and apply the provisions of policies and procedures.
- Knowledge of managed care state and federal guidelines and regulations;
- Previous experience in managed care setting;
- Familiar with medical terminology, ICD 10 and CPT coding.