Grievance & Appeals Coordinator I
1 month ago
Hiring for Grievance and appeals Coordinator
Tek Systems is currently hiring for Healthcare program coordinators for one of top healthcare company in Florida.
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. Associates degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong 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 providers offices, and claims research.
Manage large volumes of documents including copying, faxing and scanning incoming mail.
Skills:
customer service, call center, healthcare, HIPPA, medical terminology
Additional Skills & Qualifications:
Customer Services
Appeals
Grievances
100% Remote, but needs to be near WH office for occasional meetings
Experience Level:
Expert Level
About TEKsystems:We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
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