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Grievance & Appeals Coordinator I
$38,813 - $65,998/Yr
Centene - Lexington, KY
posted 2 months ago
Full-time - Entry Level
Lexington, KY
1-10 employees
Ambulatory Health Care Services
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 is essential in ensuring that member and provider complaints are handled efficiently and effectively, contributing to the overall quality of care and service provided by the organization.
Responsibilities
- Analyze and resolve verbal and written claims and authorization appeals from providers.
- 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.
- May coordinate the Grievance and Appeals Committee.
- Support the 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 grievance or appeals, claims or related managed care experience.
- Strong oral, written, and problem solving skills.
Benefits
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible work schedules (remote, hybrid, field or office)
