Grievance and Appeals Specialist

Job Summary

A company is looking for a Grievance & Appeals Specialist III to process and respond to claim appeals and disputes while providing subject matter expertise.

Key Responsibilities

• Review and process various types of appeals, ensuring accuracy and compliance with regulations
• Prepare clinical review packets and document outcomes within the claims system
• Collaborate with multiple departments to resolve grievances and ensure timely processing

Required Qualifications, Training, and Education

• High school diploma or equivalent required
• Associates Degree or equivalent relevant work experience preferred
• Minimum of three years of healthcare customer service, claims, compliance, or related experience required
• At least one year of coding experience is required
• Certified Medical Coder (CPC, RHIT, or RHIA) is preferred