Medical Appeal Resolution Specialist
7 days ago
Be a key figure in shaping the future of healthcare at Arizona Complete Health, one of the leading managed care organizations. As a Clinical Professional on our Medical Management/Health Services team, you have a unique opportunity to make a lasting impact on the lives of 28 million members.
We offer competitive benefits, including flexible work arrangements, a comprehensive benefits package, and opportunities for professional growth. Our diverse organization values individual perspectives and fosters an inclusive environment where everyone feels valued and respected.
The role involves analyzing and resolving claims and authorization appeals from providers, as well as pursuing resolution of formal grievances from members. Key responsibilities include:
- Gathering, analyzing, and reporting verbal and written member and provider complaints, grievances, and appeals
- Preparing response letters for member and provider complaints, grievances, and appeals
- Maintaining files on individual appeals and grievances
- Coordinating the Grievance and Appeals Committee (if applicable)
- Supporting pay-for-performance programs, including data entry, tracking, organizing, and researching information
- Assisting with HEDIS production functions, such as data entry, calls to providers' offices, and claims research
This role requires strong oral, written, and problem-solving skills, as well as the ability to manage large volumes of documents. A high school diploma or equivalent is required, with an associate's degree preferred. Two+ years of experience in grievance or appeals, claims, or related managed care experience is essential.
We offer a competitive salary range of $18.66 - $31.73 per hour, based on skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. We are an equal opportunity employer that values diversity and inclusion. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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