Lead Grievance & Appeals Coordinator

Centene Corporation

1d • $23 - $40

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. Position Purpose: 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

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

• Handle escalated member and provider issues
• Mentor staff and give real-time feedback
• Serve as team SME
• Support workflow and productivity
• Help drive team goals
• Research and resolve complex issues, including regulatory and CMS matters
• Identify root causes and present solutions
• Track, document, and follow up on issues
• Partner across departments to solve problems
• Support team training and procedure updates
• Deliver a high-quality customer experience
• Respond to state and market inquiries
• Assist with intake work and special projects

Benefits

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

What This Job Offers

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