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Grievance and Appeals / Prior Authorization / Claims Processor

Total Medical Staffing Columbus, OH
  • Expired: 19 days ago. Applications are no longer accepted.

Summary: Analyze and resolve verbal and written claims and
authorization appeals from providers and pursue resolution of formal
grievances from members.

Job Responsibilities: Gather, analyze and report verbal and written
member and provider complaints, grievances and appeals Prepare
response letters for member and provider complaints, grievances and
appeals Maintain files on individual appeals and grievances May
coordinate the Grievance and Appeals Committee Support the pay-for-
performance programs, including data entry, tracking, organizing, and
researching information Assist with HEDIS production functions
including data entry, calls to provider’s offices, and claims
research. Manage large volumes of documents including copying, faxing
and scanning incoming mail
Completing and resolving member grievances and appeals
Will use Prime Pega platform
Will make outbound calls to members and providers occassionally and
may also write letters.

Education/Experience: High school diploma or equivalent. Associate’s
degree preferred.0-2 years of experience

1. Appeals and Grievances Experience
2. Medicaid Experience
3. MMP ( Medicaid/Medicare) experience
4. Good coomunication skills
5. Critical Thinking skills

Total Medical Staffing

Why Work Here?

We’re an award-winning medical staffing agency delivering flexible healthcare staffing solutions.

In the rapidly-changing, highly regulated industry that is healthcare, you need a medical staffing partner who works for you. Enter TotalMed. We’re an award-winning medical staffing agency delivering flexible healthcare staffing solutions no matter how complex your needs. But even more than that, we’re a team who really cares. Our end goal is to achieve quality patient care while enhancing your employee morale. If you’re a healthcare professional in either clinical or non-clinical healthcare, our recruiters can help you navigate the sea of healthcare jobs, uncovering your ideal career path. Or, if you’re faced with open positions and short-staffed projects in either business care or patient care, TotalMed can provide customized medical staffing solutions to fulfill your hiring requirements.


4349 Easton Way, Suite 200 Columbus, OH 43219
Columbus, OH
43219 USA