Appeals & Grievance Coordinator
$47,840,000–$52,000,000 year
On-siteGrants Pass, Oregon, United States
Grants Pass, Oregon, United StatesOn-siteFull Time$47,840,000–$52,000,000 yearAssociates DegreeMedium
Full TimeAssociates DegreeMedium
Job Summary
Process and resolve Oregon Health Plan and Advantage Health Plan member and provider appeals and grievances by investigating complex complaints related to enrollment, claims, and provider payment disputes. Prepare complete case files for the medical director and coordinate care or service payments. Forward appeals to CMS Independent Review Entities or DMAP for further review, collaborating with these entities on case resolution. This role requires an on-site schedule Monday through Friday from 8:00am to 5:00pm, with a 40-hour work week.
Required Qualifications
- Associate's degree (AA) from a two-year college or university
- one to two years related experience and/or training
- equivalent combination of education and experience
- Certified Professional Coder (CPC)
- May require the use of personal vehicle for local travel
- The employee must occasionally lift and/or move up to 10 pounds
- The employee is regularly required to sit
- The employee is regularly required to use hands to finger, handle, or feel
- The employee is regularly required to talk or hear
- The employee is occasionally required to stand
- The employee is occasionally required to walk
- The employee is occasionally required to reach with hands and arms
- The employee is occasionally required to stoop, kneel, crouch, or crawl
- The employee must be able to work on-site for all scheduled shifts
- Monday - Friday; 8:00am - 5:0pm w/ a 1 hour unpaid lunch & two 15 minute paid breaks
- 40 hours per week
Desired Qualifications
- Certified Professional Coder (CPC) is strongly preferred
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.