Government Programs Appeal Coordinator (11)

Summary

Investigating and responding to medical, pharmacy, and dental grievances, the full-time Government Programs Appeal Coordinator will manage complaints and appeals while working from home.Key responsibilitiesResearch and review grievances, complaints, and appeals, ensuring appropriate documentation and compliance with mandated timeframesCommunicate effectively with members, claimants, and other departments to facilitate complete and fair reviews of casesDocument outcomes of grievances, complaints, and appeals accurately in the system and respond to independent review entity requestsRequired qualificationsHigh School diploma or equivalent6 months to 2 years of experience in medical/dental claims processing or customer service preferredKnowledge of CMS rules for Medicare and Medicaid grievance, complaint, and appeal processes preferredAbility to interpret benefit contracts and administrative policiesProficiency in computer applications such as Word and Excel

Job Description

Investigating and responding to medical, pharmacy, and dental grievances, the full-time Government Programs Appeal Coordinator will manage complaints and appeals while working from home.Key responsibilitiesResearch and review grievances, complaints, and appeals, ensuring appropriate documentation and compliance with mandated timeframesCommunicate effectively with members, claimants, and other departments to facilitate complete and fair reviews of casesDocument outcomes of grievances, complaints, and appeals accurately in the system and respond to independent review entity requestsRequired qualificationsHigh School diploma or equivalent6 months to 2 years of experience in medical/dental claims processing or customer service preferredKnowledge of CMS rules for Medicare and Medicaid grievance, complaint, and appeal processes preferredAbility to interpret benefit contracts and administrative policiesProficiency in computer applications such as Word and Excel