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Job Title: Appeals & Grievances Coordinator

Location: Remote (Must reside in Ohio; candidates located near Columbus are preferred. Training may take place at the Easton office.)

Pay: $23.00/hour

Schedule: Monday-Friday, 8:00 AM-5:00 PM (1-hour lunch between 11:00 AM and 1:00 PM)

Job Overview

We are seeking an Appeals & Grievances Coordinator to join a healthcare managed care organization supporting Medicaid members throughout Ohio. In this role, you will work alongside a collaborative team of Clinical Coordinators, licensed nurses, Appeals & Grievances Coordinators, Medical Directors, Case Managers, and Claims professionals to review member appeals, grievances, and provider disputes.

This position offers the opportunity to build experience with managed care operations, state Medicaid contracts, NCQA guidelines, and internal healthcare systems while helping ensure members and providers receive timely and accurate resolutions.

Key Responsibilities

• Review and process member appeals, grievances, and provider disputes in accordance with established timelines and regulatory requirements.
• Manage work assignments through the Prime system while maintaining strong productivity and timeliness standards.
• Prioritize aging cases to ensure deadlines are consistently met.
• Communicate with team members through email and Microsoft Teams to coordinate work, ask questions, and provide support.
• Work closely with Clinical Coordinators, Medical Directors, Case Managers, and Claims professionals throughout the review process.

Qualifications

• Previous experience reviewing healthcare claims, processing appeals or grievances, handling prior authorizations, working in provider or member services, utilization management support, medical billing, health insurance operations, or other roles involving Medicaid, Medicare, or commercial insurance is required.
• High school diploma required, associate’s degree preferred.

Why Join This Team

• Work with an experienced and supportive team that encourages collaboration and knowledge sharing.
• Gain valuable experience working with Medicaid operations, state contracts, and NCQA guidelines.
• Receive ongoing support from experienced team members who are available to answer questions and provide guidance.
• Opportunity to be considered for future full-time employment as the department evaluates long-term staffing needs.