Grievance Coordinator

Job Summary

A company is looking for a Grievance & Appeals Coordinator to manage member and provider grievances and appeals.

Key Responsibilities

• Determine and respond to claim disputes and appeals, maintaining accurate logs and documentation
• Enter accepted appeals into the CRM system and maintain case files in compliance with regulations
• Respond to inquiries from members and providers regarding grievances and appeals in a timely manner

Required Qualifications

• High school diploma/GED or equivalent working knowledge
• Two years of experience in a healthcare-related field or project management
• Knowledge of AHCCCS, HCG, and CMS regulations
• Proficiency in MS Word, Excel, and Microsoft Office Suite
• Familiarity with medical terminology and claims processing guidelines