Job Summary
A health insurance company has a current position open for a Remote Clinical Appeals and Grievances Coordinator.
Candidates will be responsible for the following:
- Preparing cases for the clinical team by gathering documentation, loading evidence, and making calls to members and providers
- Performing administrative activities
- Completing all associated data entry and authorization creation in the True care system
Applicants must meet the following qualifications:
- HS Diploma or GED
- Bachelor’s degree
- Proficiency in Microsoft Office required
- Knowledge of the New York state ART 44 PHL and federal regulatory environment
- Knowledge of claims payment process and claims data system (MHS)
- Ability to work both independently and as a team member
