Member Appeals and Grievances Coordinator for Medicaid- Remote in Virginia!

Sentara Health•Virginia Remote, VA

2d•Remote

About The Position

Sentara Health Plans is hiring a Member Appeals and Grievances Coordinator for Medicaid- Remote in Virginia! This is a full-time, permanent position with standard working hours of 8am to 5pm EST, Monday through Friday. The role is responsible for the investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations, and provider and group agreements. The Coordinator will work closely with the Plan's Medical Directors for clinical appeals/grievances and the Appeals Manager for non-clinical appeals and grievances.

Requirements

HS - High School Grad or Equivalent REQUIRED
Managed Care- 3 years REQUIRED
Previous member appeals and grievances experience preferred
Experience in JIVA and Medicaid preferred

Responsibilities

Responsible for the investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements.
Works closely with the Plan's Medical Directors who are responsible for all decision regarding clinical appeals/ grievances and the Appeals Manager who is responsible for non-clinical appeals and grievances.

Benefits

Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.