Appeals and Grievances Admin

Amerihealth Caritas•,

7d•Hybrid

About The Position

Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

Requirements

High School/GED.
1 to 3 years Medicare/Medicaid experience and minimum of 2 years of experience dealing with the public.
Medicare Advantage and MMP experience.
Medical terminology, ICD, CPT and coding experience.
Experience handling multiple call lines and triaging calls.
Access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required.

Nice To Haves

Associate’s Degree preferred.

Responsibilities

Screen calls from members and providers regarding the Part C, Part D and Medicare-Medicaid Plan grievance processes.
Serve as a backup to retrieve grievances from the Customer Service database and email distribution lists and assign them appropriately to Grievance Investigators.
Support grievance needs of our Medicare Advantage D-SNP and MMP membership.
Complete First Call Resolution cases, including intake, determining if case is fully resolved, generate letters and close case. If cases are not fully resolved, convert to standard grievance and assign to an investigator.
Generate Acknowledgement Letters to mail to appellants and answer general appeal status questions.
Assist Investigation Specialists with grievance resolutions.
Limited availability on weekends and holidays to monitor work queues.