Coordinate the informal provider payment dispute process and determine the necessary actions to resolve the problem. * Coordinate the member grievance and appeal process with Appeals Coordinator.
Coordinate the informal provider payment dispute process and determine the necessary actions to resolve the problem. * Coordinate the member grievance and appeal process with Appeals Coordinator.
Appeals Coordinator
$23.50 - $29/hr
Provides high level of accuracy and quality in produced materials and interactions with members and providers. ESSENTIAL FUNCTIONS: Maintain a caseload of appeals, non-authorizations, provider ...
Appeals Coordinator
$23.50 - $29/hr
Provides high level of accuracy and quality in produced materials and interactions with members and providers. ESSENTIAL FUNCTIONS: Maintain a caseload of appeals, non-authorizations, provider ...
Appeals Coordinator
Baton Rouge, LA · On-site
$17 - $21.50/hr
As an Appeals Coordinator you will represent the customer, the Louisiana Department of Health (LDH ... We provide opportunities to advance your career with a vast portfolio of businesses and a global ...
Appeals Coordinator
Baton Rouge, LA · On-site
$17 - $21.50/hr
As an Appeals Coordinator you will represent the customer, the Louisiana Department of Health (LDH ... We provide opportunities to advance your career with a vast portfolio of businesses and a global ...
APPEALS COORDINATOR
Baltimore, MD · On-site
$21.75 - $27/hr
These functions are required by CMS so that we provide a nationwide alert to all states and ... This position coordinates all appeals and ensures Program staff adheres to procedural requirements ...
APPEALS COORDINATOR
Baltimore, MD · On-site
$21.75 - $27/hr
These functions are required by CMS so that we provide a nationwide alert to all states and ... This position coordinates all appeals and ensures Program staff adheres to procedural requirements ...
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Coord
$22.50 - $28/hr
The role supports case development, documentation review, matched-specialty coordination, member and provider outreach, appeal correspondence, committee preparation, and audit-ready file completion.
Clinical Appeals Coord
$22.50 - $28/hr
The role supports case development, documentation review, matched-specialty coordination, member and provider outreach, appeal correspondence, committee preparation, and audit-ready file completion.
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Appeals Coordinator
Baton Rouge, LA · On-site
$17 - $21.50/hr
As an Appeals Coordinator you will represent the customer, the Louisiana Department of Health (LDH ... We provide opportunities to advance your career with a vast portfolio of businesses and a global ...
Appeals Coordinator
Baton Rouge, LA · On-site
$17 - $21.50/hr
As an Appeals Coordinator you will represent the customer, the Louisiana Department of Health (LDH ... We provide opportunities to advance your career with a vast portfolio of businesses and a global ...
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Appeals Coordinator
Baton Rouge, LA · On-site +1
$17 - $21.50/hr
As an Appeals Coordinator you will represent the customer, the Louisiana Department of Health (LDH ... We provide opportunities to advance your career with a vast portfolio of businesses and a global ...
Appeals Coordinator
Baton Rouge, LA · On-site +1
$17 - $21.50/hr
As an Appeals Coordinator you will represent the customer, the Louisiana Department of Health (LDH ... We provide opportunities to advance your career with a vast portfolio of businesses and a global ...
HP Grievance & Appeals Coordinator
$22.50 - $28/hr
POSITION SUMMARY This position handles member and provider grievances, appeals and claim disputes. This position will act as a key advocate and contact for HP members with general health care and ...
HP Grievance & Appeals Coordinator
$22.50 - $28/hr
POSITION SUMMARY This position handles member and provider grievances, appeals and claim disputes. This position will act as a key advocate and contact for HP members with general health care and ...
Grievance and Appeals Coordinator
Columbus, OH · Remote
$23/hr
Grievance & Appeals Coordinator I Contract Type / Duration: 6-Month Contract | Potential Extension ... Review and process verbal and written member grievances, provider complaints, disputes, and appeals.
New
Quick apply
Grievance and Appeals Coordinator
Columbus, OH · Remote
$23/hr
Grievance & Appeals Coordinator I Contract Type / Duration: 6-Month Contract | Potential Extension ... Review and process verbal and written member grievances, provider complaints, disputes, and appeals.
New
Medicare Appeals Coordinator
Somerville, MA · Remote
$24 - $29.75/hr
Together, we are providing our members with innovative solutions centered on their health needs to ... The Appeals Coordinator will coordinate, process, investigate, and document all aspects of member ...
Medicare Appeals Coordinator
Somerville, MA · Remote
$24 - $29.75/hr
Together, we are providing our members with innovative solutions centered on their health needs to ... The Appeals Coordinator will coordinate, process, investigate, and document all aspects of member ...
Grievances and Appeals Coordinator
$21.75 - $27/hr
The Grievances and Appeals Coordinator processes, tracks and follows up on all medical necessity ... Prepare response letters, notifications, and acknowledgements for members and provider complaints ...
Grievances and Appeals Coordinator
$21.75 - $27/hr
The Grievances and Appeals Coordinator processes, tracks and follows up on all medical necessity ... Prepare response letters, notifications, and acknowledgements for members and provider complaints ...
Medicare Appeals Coordinator
Somerville, MA · On-site +1
$24 - $29.75/hr
Together, we are providing our members with innovative solutions centered on their health needs to ... The Appeals Coordinator will coordinate, process, investigate, and document all aspects of member ...
Medicare Appeals Coordinator
Somerville, MA · On-site +1
$24 - $29.75/hr
Together, we are providing our members with innovative solutions centered on their health needs to ... The Appeals Coordinator will coordinate, process, investigate, and document all aspects of member ...
Grievances and Appeals Coordinator
Franklin, TN · On-site
$21.75 - $27/hr
The Grievances and Appeals Coordinator processes, tracks and follows up on all medical necessity ... Prepare response letters, notifications, and acknowledgements for members and provider complaints ...
Grievances and Appeals Coordinator
Franklin, TN · On-site
$21.75 - $27/hr
The Grievances and Appeals Coordinator processes, tracks and follows up on all medical necessity ... Prepare response letters, notifications, and acknowledgements for members and provider complaints ...
Grievances and Appeals Coordinator
Franklin, TN · On-site
$21.75 - $27/hr
The Grievances and Appeals Coordinator processes, tracks and follows up on all medical necessity ... Prepare response letters, notifications, and acknowledgements for members and provider complaints ...
Grievances and Appeals Coordinator
Franklin, TN · On-site
$21.75 - $27/hr
The Grievances and Appeals Coordinator processes, tracks and follows up on all medical necessity ... Prepare response letters, notifications, and acknowledgements for members and provider complaints ...
HP Grievance & Appeals Coordinator
Phoenix, AZ · Remote
$20.75 - $25.75/hr
POSITION SUMMARY This position handles member and provider grievances, appeals and claim disputes. This position will act as a key advocate and contact for HP members with general health care and ...
HP Grievance & Appeals Coordinator
Phoenix, AZ · Remote
$20.75 - $25.75/hr
POSITION SUMMARY This position handles member and provider grievances, appeals and claim disputes. This position will act as a key advocate and contact for HP members with general health care and ...
Grievance & Appeals Coordinator I
Dayton, OH · On-site
$23/hr
Grievance & Appeals Coordinator I Location: Remote within Ohio; occasional training may take place ... Coordinate or provide administrative support for grievance and appeals committee activities as ...
Quick apply
Grievance & Appeals Coordinator I
Dayton, OH · On-site
$23/hr
Grievance & Appeals Coordinator I Location: Remote within Ohio; occasional training may take place ... Coordinate or provide administrative support for grievance and appeals committee activities as ...
Provider Appeals Coordinator information
See salary details
$12.50 - $14.62
0% of jobs
$14.62 - $16.74
0% of jobs
$16.74 - $18.86
6% of jobs
$18.86 - $20.98
18% of jobs
$21.07 is the 25th percentile. Wages below this are outliers.
$20.98 - $23.10
19% of jobs
The median wage is $23.67 / hr.
$23.10 - $25.22
25% of jobs
$26.24 is the 75th percentile. Wages above this are outliers.
$25.22 - $27.34
14% of jobs
$27.34 - $29.46
5% of jobs
$29.46 - $31.58
5% of jobs
$31.58 - $33.70
4% of jobs
$33.70 - $35.82
3% of jobs
$12
$24
$35
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Full-time
Medical, Dental, Retirement, PTO
Posted 25 days ago
Job description
The Appeals Specialist will be responsible for the appeals process from receipt to resolution for both provider appeals and member appeals, grievances, and complaints. This position will research and resolve complex issues related to claims and enrollment, provider payment disputes, reversals, member authorization denials, and service quality complaints. The Appeals Specialist will schedule member appeals and lead the Grievance and Appeal Committee meetings for members to appeal authorization denials and/or quality complaints. Finally, this position is responsible for tracking and reporting on data related to these processes. This position will report to the Director of Provider Relations.
Essential Position Functions
- Coordinate the formal provider appeals process both internally for first level and externally for second level appeals. This includes, preparing and sending letters, scheduling, and leading the appeal meeting, and drafting and sending resolution.
- Coordinate the informal provider payment dispute process and determine the necessary actions to resolve the problem.
- Coordinate the member grievance and appeal process with Appeals Coordinator. This includes member contact and coordination (verbal and written correspondence), tracking grievances and appeal, scheduling and leading Grievance and Appeal Committee, clinical consultations with the Health Management Department, and internal and external reporting.
- Coordinate member complaint process. This includes member contact and coordination (verbal and written correspondence), tracking complaints, scheduling and leading Grievance and Appeal Committee, and internal and external reporting
- Research and resolve complex claims that pertain to membership or billing issues; send claim and payment reversals to appropriate staff if necessary.
- Work closely with the Internal Coder and Claims management team to resolve billing issues. Provide education to providers if appropriate.
- Appeals Specialist will review all decisions and generate resolution letters for member and provider appeals.
- Excellent verbal and written communication skills required;
- One to two years of customer service experience focusing on customer complaint resolution is preferred;
- Bachelor’s degree preferred or equivalent experience required;
- Knowledge of the health insurance industry preferred;
- Organized and attentive to detail;
- Proficiency with Microsoft Word, Excel is required.
- Ability to work well with many different personality types;
- Excellent work ethic with the ability to work in a team environment as well as independently;
- Strong analytical and problem solving skills.
The Cooperative is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. The Cooperative is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees and members feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.
About Group Health Cooperative of Eau Claire
Sourced by ZipRecruiter
Industry
Insurance services
Company size
51 - 200 Employees
Headquarters location
Altoona, WI, US
Year founded
1976