BusinessOperations - Grievance & Appeals Coordinator I - 210056

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

Education/Experience: 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.

" 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

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Education/Experience: 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. 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 grievance Manage large volumes of documents including copying, faxing and scanning incoming mail.
Story Behind the Need
Temp role to assist with increase case volume, approved by staffing committee.
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?	Handling Member Appeals. Will create the acknowledgement letter that goes to the provider. Will also build authorizations for medical review and coordinate closure and final letter to member and provider. Great team culture, ability to work closely with our member and provider population in AZ.
Candidate Requirements
Required: High School Diploma/GED			Preferred:
Required:			Preferred:
Years of experience required: 2 +years AZ Medicaid or healthcare administration. Performance indicators: Monthly metrics 8-10 intakes per hour Disqualifiers: No health insurance or healthcare background Additional qualities to look for: Claims background, reviewing reconsiderations. Certified professional coders
Top 3 must-have hard skills stack-ranked by importance	1	Processing Member appeals.
	2	Working with Prior authorizations.
	3	Microsoft Office (Outlook, Word, Excel)-
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations	Projected Manager Candidate Review Date:			ASAP
	Type of Interviews:			Teams- cameras on
	Required Testing or Assessment (by Vendor):			basic computers skills test.