Grievance & Appeals Coordinator I

Centene Corporation Tampa , FL 33602

Posted 3 weeks ago

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

Gather, analyze and report verbal and written member and provider complaints, grievances and appeals

Prepare response letters for member and provider complaints, grievances and appeals

Maintain files on individual appeals and grievances

May coordinate the Grievance and Appeals Committee

Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information

Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research.

Manage large volumes of documents including copying, faxing and scanning incoming mail

Education/Experience: High school diploma or equivalent.

Associate's degree preferred. 2 years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.



icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Lead Grievance & Appeals Coordinator

Centene Corporation

Posted 4 months ago

VIEW JOBS 7/9/2021 12:00:00 AM 2021-10-07T00:00 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 Education/Experience: Bachelor's degree in related field or equivalent experience. 2 years of grievance and appeals experience in a Healthcare or Managed Care setting. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Centene Corporation Tampa FL

Grievance & Appeals Coordinator I

Centene Corporation