Ohio Licensed Appeals Coordinator

Job Summary

A company is looking for a Temporary Coordinator remote - Appeals & Grievances.

Key Responsibilities

• Document and route appeal requests or grievances to appropriate clinical personnel
• Conduct investigations of grievances, appeals, and provider claim disputes
• Prepare case files for submission to the Independent Review Entity and ensure compliance with regulatory requirements

Required Qualifications

• Bachelor's degree or equivalent combination of education and experience
• Three years of customer service or appeals and grievance experience, preferably in managed care
• Legal or regulatory background or experience is highly desired
• Familiarity with claims processing and coordination of benefits
• Ability to interpret and apply Federal law and regulatory requirements