Appeals Coordinator, Health Plan

Overview

Employer Industry: Healthcare Services

Why consider this job opportunity:

• Full-time position with a structured 40-hour work week
• Opportunity for career advancement and growth within the organization
• Comprehensive healthcare benefits, including vision and dental, available from day one
• Supportive and collaborative work environment
• Chance to make a positive impact on member experiences and quality of care
• Work remotely from home in Pennsylvania

• Prepare and facilitate member appeals, complaints, and grievances by communicating with members, their representatives, vendors, and medical providers
• Investigate details of appeals and grievances by consulting with healthcare providers and internal medical staff
• Document all communications accurately within case files and departmental tracking databases
• Ensure compliance with all regulatory time frames and guidelines set by relevant authorities
• Act as the primary resource regarding the appeals and grievance processes for internal and external entities

• High School Diploma or Equivalent (GED)
• Minimum of 5 years of relevant experience
• Strong communication and multitasking skills
• Ability to work independently
• Knowledge of applicable laws and regulations related to healthcare appeals and grievances

• Experience in healthcare administration or related fields
• Familiarity with regulatory agencies such as DOL, DOH, DOI, NCQA, and CMS
• Proven ability to implement policy changes effectively
• Experience in conducting audits and maintaining databases
• Skills in coordinating educational sessions or committee activities

#Healthcare Services #Career Opportunity #Remote Work #Healthcare Benefits #Compliance

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