Healthcare Grievance and Appeals Coordinator

A-Line Staffing Solutions
Published
February 18, 2021
Location
Woodland Hills, CA
Category
Job Type

Description

Full time Healthcare Grievance and Appeals Coordinator openings in Woodland Hills, Los Angeles, CA 91367 area with a major healthcare company! Starting ASAP!! Apply now to Thu Phan with A-Line!

  • PAY RATE: $22
  • HOURS: Full Time Monday-Friday 8:00am-5:00pm

Summary:

  • Not a call center position but you will have communication with members. You will be expected to handles cases from beginning to end (will have support from leads and supervisors). Your daily case load is 30-40, however the expectation is to work 5-7 cases daily.

Position Responsibilities:

  • Analyze and resolve verbal and written claims and authorization appeals from providers and 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
  • 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 providers offices, and claims research.
  • Manage large volumes of documents including copying, faxing and scanning incoming mail

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