HP Grievance & Appeals Coordinator

Banner Health•Phoenix, AZ

10d•$21 - $32•Remote

About The Position

The HP Grievance & Appeals Coordinator handles member and provider grievances, appeals, and claim disputes, serving as a key advocate and contact for members with health care and accessibility concerns. The role manages the intake, review, investigation, and resolution of cases, researches complex claim and service issues, identifies appropriate review levels, coordinates with internal teams and providers, documents findings, and prepares professional correspondence. This is a high-volume, fast-paced role requiring knowledge of grievance and appeals processes, attention to detail, sound judgment, strong written communication, and efficient use of multiple systems. The position works primarily remotely, and candidates must reside in Arizona. The schedule is 8:00 a.m.–5:00 p.m., Monday through Friday. The position works under supervision and interacts with staff across the organization.

Requirements

High school diploma, GED, or equivalent working knowledge.
Two years of work experience in a health care-related field or experience managing projects or 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.
Knowledge of medical terminology, claims processing guidelines, CRM and IDX, and grievance, appeal, and claim dispute processes.
Strong interpersonal, organizational, problem-solving, oral communication, and written communication skills.
Ability to work independently, meet deadlines and timelines, and work with healthcare professionals at various levels.
Ability to be flexible and manage multiple projects under tight time constraints.
Strong analytical, critical-thinking, and time-management skills, with the ability to prioritize multiple daily tasks.
Ability to quickly identify, summarize, and present options for issues and consistently meet or exceed regulatory reporting requirements.
Must reside in Arizona to be considered.

Nice To Haves

Additional related education and/or experience.

Responsibilities

Screen claim disputes for eligibility, including untimely claims and resubmissions; log, categorize, and track documents and notices; route or respond to cases that do not meet criteria; and help resolve member questions to prevent formal grievances or appeals.
Enter accepted appeals and claim disputes and related information into the CRM; create and maintain case files and review sheets; update cases with reviewer responses; and assess case information for referral or transmission to coworkers.
Ensure appeals and claim disputes are acknowledged through official correspondence within AHCCCS, HCG, and CMS contractual timelines, while protecting confidential information.
Coordinate and communicate with employees, providers, Medical Directors, Plan Administrators, RNs, Risk Management, attorneys, AHCCCS, HCG, CMS, and other appropriate parties regarding appeals.
Answer incoming calls and research and resolve member and provider questions concerning grievances, appeals, and claim disputes.
Open, review, date-stamp, route, or respond to incoming mail and address grievances, appeals, and claim disputes in a timely manner consistent with regulations, policies, and organizational values.
Prepare and submit resolution and extension correspondence using applicable Arizona statutes, administrative code, federal regulations, and other supporting policies and statutes; conduct daily self-audits for regulatory compliance.
Gather relevant medical records, coding, and claim documentation for reviewers; troubleshoot and resolve special-handling requirements.
Report incoming, attended, and scheduled State Fair Hearings at Grievance/Appeals meetings, as appropriate.
Coordinate with other departments to facilitate timely responses and inquiries, assist with workgroups as requested, and provide technical expertise on grievances, appeals, and claim disputes.
Prioritize information from multiple sources to provide quality care and support while meeting deadlines and regulatory reporting requirements.