Grievance & Appeals Intake Coordinator

• Enter grievance and appeals cases into the G&A system to launch the case for research and resolution
• Complete the AOR process on required cases
• Reviews, and processes appeals and grievances filed by patients
• Assists with adherence to regulatory requirements, conducts internal audits, and addresses any identified compliance issues with the Complaint and Appeals policies and procedures
• Conducts reviews of decisions and case files to determine if there are errors in the application of law or evidence
• Drafts and sends appeal decision letters
• Identifies key performance indicators (KPIs) and metrics to evaluate the effectiveness and efficiency of the appeals and grievances process
• Documents patient billing questions and concerns
• Prepares educational materials, training programs, or presentations to enhance understanding of the appeals and grievances process
• Coaches junior colleagues on best practices and standard operating procedures
• Assists with the training of junior-level staff to promote the development of departmental capabilities

• Working knowledge of problem solving and decision making skills
• Grievance and appeals experience
• High School Diploma

Health Insurance Call Center

• Affordable medical plan options
• 401(k) plan with matching company contributions
• Employee stock purchase plan
• Wellness screenings
• Tobacco cessation programs
• Weight management programs
• Confidential counseling
• Financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access