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Health First - Rockledge, FL
posted 2 months ago
Full-time - Entry Level
Rockledge, FL
Ambulatory Health Care Services
About the position
The HFHP Appeals/Grievance Coordinator is responsible for resolving member complaints in a timely and professional manner while ensuring compliance with healthcare regulations and standards. This role involves researching, documenting, and analyzing complaints, preparing case files, and collaborating with various departments to enhance member experiences and minimize financial risks.
Responsibilities
- Research, document, analyze, and resolve member complaints according to complex rules.
- Maintain understanding of laws, regulations, and standards guiding complaint handling.
- Prepare thorough and well-documented case files for internal reviewers.
- Compose professional and legally-sound correspondence related to member complaints.
- Collaborate with other departments to resolve member complaints effectively.
- Elevate issues to senior management to minimize financial risks.
- Report trends to help reduce medical or pharmacy costs.
Requirements
- High School education or equivalent; some college preferred.
- Minimum one year of experience with healthcare business office or health plan.
- Advanced knowledge of prescription drug coverage concepts.
- Advanced knowledge of healthcare financing and delivery.
- Advanced knowledge of Medicare eligibility, coverage, and payment provisions.
- Advanced knowledge of commercial insurance provisions.
- Experience working collaboratively with others to achieve goals.
- Demonstrated ability to communicate professionally.
Nice-to-haves
- Experience in a fast-paced and stressful environment.
- Ability to handle conflict productively.
- Ability to work flexible hours as required.
Benefits
- Prescription drug insurance
