Grievance & Appeals Coordinator

🕒 August 5

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $20 - $30 / hour

⏱ Part Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 20%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Banner Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1999

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Banner Health is a leading healthcare system committed to making healthcare easier through comprehensive patient services and resources. They provide a safe place for care with services ranging from emergency and urgent care, imaging, and surgery centers to maternity and hospice care. Banner Health also offers telehealth options to ensure access to healthcare, regardless of location. They support athletes through Banner Orthopedics & Sports Medicine and have been recognized for exceptional patient care. With advanced digital tools, they aim to manage healthcare seamlessly for their patients.

📋 Description

• Intake, review, investigate and resolve member and provider grievances, appeals and claim disputes • Screen claim disputes for acceptable criteria, including untimely claims and resubmissions • Maintain logs, categorize and track documents, notices and returned receipts • Respond to appeals and disputes that do not meet criteria through correspondence and routing • Assist members with healthcare questions and concerns to prevent formal grievances or appeals • Enter accepted appeals and disputes into CRM systems and maintain case files • Prepare review sheets for Medical Review and Claim Review according to policy and AHCCCS, HCG and CMS regulations • Update CRM records with reviewer responses and document case information for referrals or transmission • Send acknowledgment correspondence within contractual timelines and protect confidential information • Coordinate appeal information with employees, providers, Medical Director, Plan Administrator, RNs, Risk Management, attorneys, AHCCCS, HCG and CMS • Answer incoming calls and research and resolve member and provider questions • Review, date stamp, route or respond to incoming mail • Create and submit resolution and extension correspondence using applicable Arizona statutes, administrative code, federal regulations and supporting policies • Self-audit daily for regulatory compliance • Gather medical records, coding and claim documentation for reviewers • Troubleshoot and resolve special handling requirements • Report State Fair Hearings at Grievance/Appeals meetings • Collaborate with internal departments and assist with workgroups • Provide technical expertise regarding grievances, appeals and claim disputes • Prioritize data from multiple sources while working under supervision in a fast-paced environment

🎯 Requirements

• High school diploma/GED or equivalent working knowledge • Two years of work experience in a health care related field or experience managing projects/initiatives, or an equivalent combination of education and experience • Knowledge of AHCCCS, HCG and/or CMS regulations • Knowledge of MS Word, Excel and Microsoft Office Suite • Knowledge of medical terminology, claims processing guidelines, and CRM & IDX • Knowledge of grievance, appeal and claim dispute processes • Strong interpersonal, organizational and problem solving skills • Strong oral and written communication skills • Ability to work independently and meet deadlines/timelines • Ability to work with various levels of healthcare professionals • Ability to work on multiple projects simultaneously under tight time constraints • Strong analytical, critical-thinking and time management skills • Ability to prioritize multiple tasks daily • Ability to identify, summarize and present options to issues • Ability to meet and exceed regulatory reporting requirements • Candidates must reside in the state of Arizona • Completion of post-offer Occupational Health physical assessment, drug screen and background check is required • Additional related education and/or experience preferred

🏖️ Benefits

• Remote work setting • Banner Health total rewards package (value not included in posted base salary range) • Registry/Per Diem positions do not have guaranteed hours • No medical benefits package is offered for Registry/Per Diem positions • Post-offer Occupational Health physical assessment, drug screen and background check