Appeals and Grievances Coordinator

Job Summary

Managing the appeals and grievances process, the full-time remote Appeals and Grievances Coordinator will serve as the primary contact for members and providers, ensuring timely and compliant resolutions for dental and vision cases while collaborating with various internal teams.

Key responsibilities

• Complete appeals and grievances for dental and vision waiver services across all states
• Analyze medical records and documentation to make informed decisions and communicate outcomes effectively
• Document rationale and collaborate with internal teams to resolve complex cases within regulatory timeframes

Required qualifications

• High school diploma or equivalent
• 1+ years of experience with medical, dental, or vision terminology and 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 regulations and ability to manage protected health information