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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 grievances and appeals from 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 conversations, and facsimile.

Key Responsibilities
  • Prepare and manage G&A files for comprehensive review.
  • Facilitate timely communication with members and providers regarding their appeals.
  • Maintain compliance with all relevant regulations and standards.

In this role, you will be integral to the healthcare system, ensuring that all parties are informed and that processes are followed accurately.