Grievance and Appeals Coordinator
2 months ago
Full time Grievance and Appeals Coordinator openings in Los Angeles CA 91367 area with a major healthcare company Starting ASAP Apply now with Luke H. at A-line
**Will be Work-From-Home but must live near Woodland Hills, CA 91367**
Position Purpose: Will mainly be speaking with members, documenting, research, formulating responses in writing to members, will need to meet deadlines.
Job Requirements:
- Previous experience with either Grievance & Appeals, Medical management, Utilization management, and/or running a doctor’s office
- Must have Healthcare Call center experience and/or have worked in Doctors’ offices (i.e., billing, talking to members, pulling records), experience dealing with members (problem-solving, and being able to multi-task and work through various issues)
- Must have strong writing and typing skills, and be analytical and research savvy
- Working knowledge of State and/or Federal health care programs preferred (Medicaid, Medicare).
Pay: $20-22/hour
Schedule: 40-Hours/Week – Monday-Friday anywhere between 8am-6pm (staggered shifts)
Responsibilities:
- 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 provider’s offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail
Why Apply:
- Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
- 401k after 1 year of employment: With employer match and profit sharing
- GREAT Hours Monday through Friday, 40 hours per week, No Weekends
- Competitive Pay Rate
Keywords: Medical Billing, Medical Coding, Provider Services, Grievance, Appeals, Denials, Grievance and Appeals, Appeals and Denials, Medical Claims, Claims, Billing and Coding, Reimbursement, Collections, HEDIS, Member Services, CMS, Managed Care, MCO, Benefit Verification, Clinical Care, Clinical Service, Clinical Coordinator, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Reimbursement Counselor, Medical Customer Service, Healthcare, Inbound Calls, Outbound Calls, Medicare, Medicaid.
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