A leading Managed Care Company based out of Dayton, OH is seeking 2 fully remote Grievances and Appeals Coordinator I for a 9-10 month contract opportunity. The Grievance & Appeals Coordinator I, in collaboration with department leadership, is responsible for all daily appeals logging and coordination of all State Hearings.
Essential Functions:
* Ensure regulatory compliance and HIPAA guidelines are met for Medicaid, Medicare, and future lines of business
* Document appeals in Facets
* Request medical/dental records from providers
* Prepare all appeals and grievances and forward to the appropriate team once the information is received
* Log State Hearings for Clinical Appeals Nurses
* Complete appeal and State Hearing files to be ready for filing
* Provide support to the department, including filing, printing, copying, including the preparation of new appeal and State Hearing files
* Perform triage on incoming mail, emails, and faxes
* Scan mail for retention in electronic files
* Log and index grievances and appeals in Facets and OnBase
* Create and mail acknowledgment letters for grievances and appeals
* Perform UAT Testing when necessary
* Report monthly key statistics for all lines of business to the management team
* Perform any other job duties as requested
1+ years of customer service, healthcare administration/mgmt.. or grievance and appeals experience
Intermediate skills on Microsoft Word, Excel and Access
HS Diploma or equivalent
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.