Lead Grievance & Appeals Coordinator

Centene Corporation • Remote-IL, IL

2d • $23 - $40 • 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. This position is remote/work from home supporting our Illinois Health Plan Medicaid and YouthCare Grievance & Appeals Processing Team. The work schedule is Monday - Friday 8AM - 5PM Central Time Zone with over-time as needed during the week and approximately every other weekend for some on-call duties.

Requirements

• Bachelor’s degree in related field or equivalent experience.
• 2+ years of grievance and appeals experience in a Healthcare or Managed Care setting.

Responsibilities

• Maintain a smaller caseload
• Provide updates on status' of: daily case completion by assigned team members, error management, run daily huddles, contribute to job aids, Q&As, support process changes, coaching staff, and support state fair hearing process as needed; among other duties.
• Provide support and direction for the daily operations of the appeals function
• Provide consultation for problem resolution for appeals staff and monitor team work output to ensure compliance with internal and NCQA standards
• Identify training, process improvement and resource needs to maximize team performance and recommend action plans to management
• Review denial and appeal letters as needed to ensure appropriate content and message
• Prepare for state/health plan audits, response to complaints and request for state fair hearing documentation
• Prepare monthly reports, logs, and other health plan or state contractual requirements
• Review and monitor team workload and output to ensure optimum efficiency and accuracy
• Serve as the point of contact for issues that arise from members, providers and internal team
• Train and educate new and existing team on processes, policies and procedures, and contract or market requirements
• Performs other duties as assigned
• Complies with all policies and standards

Benefits

• competitive pay
• health insurance
• 401K
• stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level