About the position
As a Grievance & Appeals Coordinator I at Arizona Complete Health, you will play a crucial role in our Medical Management/Health Services team, impacting the lives of our 28 million members. This hybrid position requires you to work in our Tempe, AZ office 2-4 days per month, allowing for a flexible work environment. Your primary responsibility will be to analyze and resolve both verbal and written claims and authorization appeals from providers, while also pursuing resolutions for formal grievances from our members. In this role, you will gather, analyze, and report on member and provider complaints, grievances, and appeals. You will be responsible for preparing response letters for these complaints and maintaining organized files on individual appeals and grievances. Additionally, you may coordinate the Grievance and Appeals Committee, ensuring that all processes are followed and documented appropriately. You will also support our pay-for-performance programs, which will involve data entry, tracking, organizing, and researching relevant information. Assisting with HEDIS production functions will be part of your duties, including making calls to provider offices and conducting claims research. Managing large volumes of documents, including copying, faxing, and scanning incoming mail, will be essential to your success in this position.
Responsibilities
- Analyze and resolve verbal and written claims and authorization appeals from providers.
- Pursue resolution of formal grievances from members.
- 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.
- Coordinate the Grievance and Appeals Committee as needed.
- Support 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.
Requirements
- High school diploma or equivalent required; Associate's degree preferred.
- 2+ years of experience in grievance or appeals, claims, or related managed care experience.
- Strong oral and written communication skills.
- Excellent problem-solving skills.
Nice-to-haves
- Experience in healthcare or managed care environments.
- Familiarity with HEDIS metrics and reporting.
Benefits
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible work schedules including remote, hybrid, field, or office work options.
