HP Grievance & Appeals Coordinator
$41,621–$62,421 year
RemoteArizona, United States
Job Summary
Determine which claim disputes meet acceptable criteria by screening for untimely claims and resubmissions, then route or respond with appropriate correspondence. Enter accepted appeals and claim disputes into the CRM, maintaining case files and review sheets per AHCCCS, HCG, and CMS regulations. Research complex issues, document findings, and prepare professional acknowledgment and resolution letters while ensuring compliance with Arizona statutes and federal regulations. Respond to incoming phone calls, mail, and inquiries regarding grievances and appeals, coordinating with internal teams, providers, and external entities to resolve disputes efficiently. Self-audit daily to verify adherence to regulatory requirements and timelines.
Required Qualifications
- CANDIDATES MUST RESIDE IN THE STATE OF ARIZONA TO BE CONSISDERED
- Work shifts will be 8:00 a.m.-5:00 p.m. Monday-Friday
- Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes employment, criminal and education) is required
- High school diploma/GED or equivalent working knowledge
- Two years of work experience in 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 required
- 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 required
- Ability to work independently ensuring all deadlines/timelines are met and to work with various levels of healthcare professionals
- Ability to be flexible and work on a variety of projects simultaneously under tight time constraints
- Strong analytical, critical-thinking and time management skills
- Strong organizational skills and ability to prioritize multiple tasks daily
- Ability to quickly identify, summarize and present (verbally and orally) options to issues which may arise, and to consistently meet and exceed regulatory reporting requirements for all lines of business
Desired Qualifications
- Additional related education and/or experience preferred
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