Grievance & Appeals Coordinator.

$43,680 - $45,760/Yr

Pyramid Consulting - Nashville, TN

Full-time - Entry Level

Remote - Nashville, TN

Professional, Scientific, and Technical Services

About the position

The Grievance & Appeals Coordinator is responsible for managing correspondence with members, providers, and regulators regarding decisions and actions related to grievances and appeals. This role involves collaboration with various departments within the organization, adherence to compliance requirements, and promoting professional growth through continuing education. The position is a contract opportunity with potential for long-term employment, primarily remote, based in Nashville, TN.

Responsibilities

• Correspond with members, providers, and regulators regarding decisions and actions.
• Collaborate with Claims, Customer Service, Appeals, and Medical Management Departments.
• Communicate and cooperate with internal and external business partners.
• Adhere to Compliance/Program Integrity requirements and comply with HIPAA Regulations.
• Promote individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
• Support department-based goals contributing to the success of the organization.

Requirements

• 1 year of Grievance & Appeals experience or 1+ year of Customer Service experience at a health insurance company.
• Strong written and verbal communication skills.
• PC proficiency including Microsoft Office products.
• One year of health insurance/managed care experience performing Appeals and Grievances functions.
• Ability to manage large caseloads in a fast-paced environment.
• Demonstrated problem-solving and organizational skills.
• Ability to converse and collaborate with physicians and physician personnel.
• Ability to track and manage case load effectively in a Grievance tracking system.
• High school diploma and two years in a Medicare, Medicaid managed care environment investigating and resolving Grievances.

Nice-to-haves

• Bilingual in Spanish is preferred but not required.
• Previous experience working in a remote setting is preferred.

Benefits

• Health insurance (medical, dental, vision)
• 401(k) plan
• Paid sick leave