Grievance & Appeals Coordinator

Centene Management Company•Woodland Hills, CA

4d•$19 - $33•Remote

About The Position

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Fully remote position with a Monday–Friday schedule, 8:00 AM–5:00 PM PST California residency required for consideration Preference given to candidates located near Woodland Hills, CA Healthcare call center experience strongly preferred Minimum 2+ years of experience in one or more of the following: Grievances and appeals Claims Managed care Related or transferable healthcare experience Position Purpose: 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.

Requirements

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

Nice To Haves

Preference given to candidates located near Woodland Hills, CA
Healthcare call center experience strongly preferred
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.