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Grievance & Appeals Coordinator I
Meridian Illinois - Burr Ridge, IL
posted 2 months ago
About the position
The Grievance & Appeals Coordinator I plays a crucial role in analyzing and resolving claims and authorization appeals from providers, as well as addressing formal grievances from members. This position involves gathering, analyzing, and reporting complaints, preparing response letters, and maintaining organized files on appeals and grievances. The role supports various programs and functions within the Medical Management/Health Services team, contributing to the overall efficiency and effectiveness of the organization.
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; Associate's degree preferred.
- 2+ years of grievance or appeals, claims, or related managed care experience.
- Strong oral, written, and problem-solving skills.
Benefits
- 401(k)
- Health insurance
- Paid holidays
- Paid time off
- Tuition reimbursement
