Grievance & Appeals Coordinator I

Centene Corporation•Tempe, AZ

2d•Onsite

About The Position

This position is for a Grievance & Appeals Coordinator I on the Medical Management/Health Services team at Centene. The role is an in-office position, Monday - Friday, 8AM to 5PM. The coordinator will manage large volumes of documents including copying, faxing, and scanning incoming mail. The primary purpose is to analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. This involves gathering, analyzing, and reporting member and provider complaints, grievances, and appeals, preparing response letters, and maintaining files. The role may also coordinate the Grievance and Appeals Committee, support pay-for-performance programs (including data entry, tracking, organizing, and researching information), and assist with HEDIS production functions (including data entry, calls to provider’s offices, and claims research). The position requires compliance with all policies and standards.

Requirements

High school diploma or equivalent
2+ years grievance or appeals, claims, related managed care experience, or relevant experience

Nice To Haves

Associate’s degree preferred

Responsibilities

Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members
Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
Prepare response letters for member and provider complaints, grievances and appeals
Maintain files on individual appeals and grievances
May coordinate the Grievance and Appeals Committee
Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research
Manage large volumes of documents including copying, faxing and scanning incoming mail
Performs other duties as assigned
Complies with all policies and standards