Grievance & Appeals Coordinator

Job not on LinkedIn

🔥 4 hours ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $20 - $30 / hour

⏱ Part Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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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

• Determine which claim disputes meet acceptable criteria, screen untimely claims and resubmissions, maintain logs, categorize and track documents, and route or respond to appeals and disputes • Assist members with healthcare questions and concerns to help prevent formal grievances or appeals • Enter accepted appeals and claim disputes and corresponding information into CRM systems • Create and maintain case files and review sheets for medical and claim reviews • Update CRM records with reviewer responses and document information for referrals or transmissions • Acknowledge appeals and claim disputes through official correspondence within AHCCCS, HCG, and CMS contractual timelines • Protect the confidentiality of member and provider information • Coordinate appeal information with employees, providers, Medical Director, Plan Administrator, RNs, Risk Management, attorneys, AHCCCS, HCG, CMS, and others • Respond to calls and research and resolve member and provider questions regarding grievances, appeals, and claim disputes • Review, date stamp, route, or respond to incoming mail • Create and submit resolution and extension correspondence using applicable statutes, regulations, policies, and procedures • Self-audit daily for regulatory compliance • Gather medical records, coding, and claim documentation for reviewers • Troubleshoot and resolve special handling requirements related to grievance and appeal issues • Report incoming, attended, and scheduled State Fair Hearings at grievance and appeals meetings • Work with internal departments to facilitate timely responses and inquiries • Assist with workgroups and provide technical expertise on grievances, appeals, and claim disputes

🎯 Requirements

• Must reside in the state of Arizona • High school diploma/GED or equivalent working knowledge • Two years of work experience in a healthcare-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 Microsoft Word, Excel, and Microsoft Office Suite • Knowledge of medical terminology, claims processing guidelines, CRM, and 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 and timelines • Ability to work with various levels of healthcare professionals • Ability to manage multiple projects simultaneously under tight time constraints • Strong analytical, critical-thinking, and time-management skills • Ability to prioritize multiple daily tasks • Ability to identify, summarize, and present issue options verbally and orally • Ability to meet and exceed regulatory reporting requirements • Completion of post-offer occupational health physical assessment, drug screen, and background check required

🏖️ Benefits

• Registry/Per Diem positions do not have guaranteed hours and no medical benefits package is offered • Comprehensive benefit package for all benefit-eligible positions • Remote work opportunity • Drug-free work environment