Member Appeals and Grievances Coordinator for Medicaid- Remote in Virginia

Sentara Health

1d • Remote

About The Position

Sentara Health Plans is hiring an Member Appeals and Grievances Coordinator for Medicaid. This is a full-time, permanent position (40 hours) with standard working hours from 8am to 5pm EST, Monday through Friday. Remote opportunities are available in multiple states. Sentara Health Plans provides health plan coverage to close to one million members in Virginia, offering a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. The company features a robust provider network, programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services. Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years, offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The organization prides itself on a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth, with a mission to improve health every day and a vision to be the healthcare choice of the communities served. Sentara has been nominated 'Employer of Choice' for over ten years and recognized by U.S. News and World Report as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy.

Requirements

• HS - High School Grad or Equivalent REQUIRED
• Managed Care- 3 years REQUIRED

Nice To Haves

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees