Appeals and Grievances Coordinator

Job Summary

Appeals and Grievances Coordinator is a full-time role responsible for managing the appeals and grievances process for dental and vision services, collaborating with various teams to ensure compliance and timely resolutions.

Key Responsibilities

• Complete appeals and grievances for members and providers within required timeframes
• Analyze documentation and make informed decisions based on organizational and regulatory standards
• Communicate outcomes effectively and draft formal correspondence related to appeals and grievances

Required Qualifications

• High school diploma or equivalent
• 1+ years of experience with medical, dental, or vision terminology and/or coding (ICD-10, CDT, CPT)
• 1+ years of experience with case management platforms or healthcare administrative systems
• Proficiency in Microsoft Office Suite
• Demonstrated understanding of HIPAA compliance