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Grievance and Appeals Processing Specialist

2 months ago

Akron, Ohio, United States Summa Health System Full time
Position Overview

The Grievance and Appeals Processing Specialist is responsible for the meticulous creation and organization of grievance and appeal (G&A) documentation for thorough investigation.

This role ensures that all communications regarding G&A from both Members and Providers are executed punctually, adhering to CMS regulations. This includes the delivery of information through various channels such as written correspondence, electronic mail, telephone interactions, and facsimile.

Key Responsibilities
  • Prepare and manage G&A files for comprehensive review.
  • Guarantee timely communication with Members and Providers.
  • Maintain compliance with regulatory standards.

The ideal candidate will possess strong organizational skills and a commitment to upholding the highest standards of service in the healthcare sector.