State Licensed Grievance Specialist

Job Summary

Working remotely in a full-time capacity, the State Licensed Grievance Specialist will manage the processing and response to claim appeals and disputes while providing subject matter expertise in clinical and code edit denials.

Key responsibilities:

• Review and validate a variety of appeal types, including high difficulty and non-clinical appeals
• Prepare appeals for clinical review and document outcomes in the Facets system
• Collaborate with multiple departments to ensure timely resolution of grievances and appeals

Required qualifications:

• High school diploma or equivalent required; Associate's Degree preferred
• A minimum of three years of healthcare customer service or related experience, including one year of coding experience
• Intermediate skills in Microsoft Word and Excel; Access skills are a plus
• Certification as a Medical Coder (CPC, RHIT, or RHIA) is preferred
• Experience in analyzing medical record documentation for claims and appeals