Appeals & Grievances Coordinator

Point32Health - Canton, MA

Full-time - Entry Level

Canton, MA

Insurance Carriers and Related Activities

About the position

The Appeals and Grievance (A&G) Coordinator at Point32Health is responsible for managing the operational aspects of the Appeals and Grievances process in compliance with State and Federal regulations. This role involves processing appeals, coordinating with various departments, and ensuring timely and professional handling of cases. The coordinator will analyze data, track trends, and interact with providers and internal stakeholders to facilitate effective communication and resolution of grievances.

Responsibilities

• Assign new verbal and written appeals and grievances to Appeals and Grievances Analyst
• Process Fast Track Appeals including monitoring of Fast Track appeals phone line and rightfax for new cases
• Function as a liaison between A&G, Care Management, and Independent Review Organization (IRO)
• Support A&G Analyst in timely completion of Appeals and Grievances
• Adhere to all regulatory and compliance timeliness expectations
• Distribute incoming mail as well as department manual mail processing
• Perform other duties and projects as assigned.

Requirements

• Associate's degree or equivalent experience in health care, conflict resolution or related field
• 1-2 years of experience in a health care and/or administrative setting preferred
• Excellent organizational skills
• Excellent interpersonal/communication skills
• Computer skills with experience in EXCEL and WORD
• Knowledge of basic medical terminology
• Ability to manage multiple priorities and operate in a fast-paced environment
• Strong analytical and problem-solving skills
• Attention to detail and ability to work independently.

Nice-to-haves

• Experience with Medicare Part D Appeals
• Familiarity with regulatory requirements and compliance processes

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health