We have a remote position open for a Grievance & Appeals Coordinator. Please read job description and apply if you have the qualifications client is seeking.
Must submit resume to be considered for position.
This is a remote position.
Responsibilities:
...
Reviewing faxes that come from the providers and members that are appealing a denial of a medical claim. If it is a true appeal, then they will send the documents to a vendor that will review them. After the vendor makes their decision to uphold/overturn the claim, then they will follow the procedures on notifying the provider/member of the decision. Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
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 with 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
Working hours: 8:00 AM - 5:00 PM
Skills:
Associate's Degree preferred
Health Care Claim processing
Provider appealing claims
Education:
Associate
Experience:
1-4 years
Qualifications:
2+ years grievance or appeals, claims or related managed care experience
Oral, written and problem solving skills
Microsoft Word
Must be able to pass background check.
Please submit resume to be considered for position.
Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion.
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 Spherion, 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 Callcenter@spherion.com.
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, Spherion offers a comprehensive benefits package, including health, and an incentive and recognition program (all benefits are based on eligibility).