Grievance & Appeals Coordinator

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Address grievances, appeals, and claim disputes from members and providers.

• Evaluate claim disputes to ensure they meet acceptable criteria, such as timeliness and resubmissions.

• Maintain detailed logs, categorize, and track all documents, notices, and returned receipts.

• Input accepted appeals and claim disputes into CRM systems while keeping case files up to date.

• Ensure that appeals and disputes are acknowledged within the contractual timelines set by AHCCCS, HCG, and CMS.

• Respond to phone inquiries, incoming mail, and questions from members and providers.

• Investigate and resolve issues related to grievances, appeals, and claim disputes.

• Draft and submit correspondence for resolutions and extensions in accordance with relevant regulations and statutes.

• Collect medical records, coding, and claim documentation for review purposes.

• Report on State Fair Hearings during grievance and appeals meetings.

• Work collaboratively with internal departments, providing technical expertise on grievance, appeal, and claim dispute processes.

• Conduct self-audits to ensure regulatory compliance.

⛳️ Requirements

• High school diploma/GED or equivalent level of knowledge.

• Minimum of two years of experience in a healthcare-related field or in project/initiative management, or a suitable combination of education and experience.

• Familiarity with AHCCCS, HCG, and/or CMS regulations.

• Proficient in MS Word, Excel, and the Microsoft Office Suite.

• Understanding of medical terminology, claims processing guidelines, CRM, and IDX.

• Knowledge of the grievance, appeal, and claim dispute processes.

• Excellent interpersonal, organizational, and problem-solving abilities.

• Strong oral and written communication skills.

• Capability to work independently and adhere to deadlines and timelines.

• Ability to collaborate with various levels of healthcare professionals.

• Skilled in managing multiple projects under tight deadlines.

• Strong analytical, critical-thinking, and time-management abilities.

• Completion of a post-offer Occupational Health physical assessment, drug screening, and background check is required.

• Residency in Arizona is mandatory.

🏝️ Benefits

• Opportunity for remote work.

• Flexible part-time schedule.

• Registry/Per Diem positions do not guarantee hours.

• No medical benefits package is available for Registry/Per Diem positions.