Update 1/6: Pending start, Karla's Montea placed! 2nd offer out to comp 
 
HCS Job Title:  Grievance & Appeals Specialist 
Company Job Title:  Grievance & Appeals Coordinator I  
 
Working with Hiring Manager Starr Thompson and Staffing Specialist Jordan Ward 
 
Req: 167235-1 
 
No Griffin 
 
Workday JO Code: 210056 
 
Vaccination NOT REQUIRED 
# of Openings:  2 pos, 2 sub spot 
 
If Contract, Length of Assignment:  RTH 
MU or BR:  40% MU 
Compensation Notes:  $23 to $23 an hour 
Location:  Remote in South Carolina 
Shift: M-F 8-5 
Start Date: ASAP 
Interview Times/Interviewer: Virtual video with Starr Thompson 
Minimum Education/Licensures/Qualifications: 
Must include city and state on resume
<ul>
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 0.0in 0.5in;">2+ years grievance or appeals, or claims in managed care environment.
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 0.0in 0.5in;">Good job tenure, will DQ for jumpiness
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 0.0in 0.5in;">Familiarity with Medicaid, DSNP-Medicare, and/or Marketplace - Please specify on resume
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 0.0in 0.5in;">Experience with Microsoft office applications (Word, Excel, Teams, Outlook, SharePoint)
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 0.0in 0.5in;">Meeting deadlines in a fast-paced, compliance-driven environment
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt 0.5in;">High school diploma
</ul>
Soft Skills Required:

<ul>
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt 0.5in;">Strong verbal and written communication skills.
</ul>
Preferred but not a must:

<ul>
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 0.0in 0.5in;">Associates Degree
</ul>
Types of Candidates to Submit to Sales Rep: 
Best Candidate: Grievance/Appeals Coordinator with 2+ years from another MCO 
Second Best Candidate: Claims Specialist with 2+ years from another MCO         
Third Best Candidate:  Grievance/Appeals Coordinator with 2+ years in large healthcare system   
 
Day to Day Duties:

<ul>
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt 0.5in;">The daily schedule is 8:00 – 5:00 with a 1 hour lunch to be taken between 11:00 and 1:00 M-F 
	This is production role, work will be provided through a queue using the CenPas system with high focus on aging and timeliness. 
	This is a close nit team with active engagement via Microsoft Teams
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt 0.5in;">• 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 
	 
</ul>
 
What previous job titles or background work well in this role? 
Grievance and appeals coordinator, claims specialist 
 
 
What makes this role interesting/team culture/market comparison: 
Candidates for this role will be joining a tight-knit team of Clinical Coordinators (licensed nurses) and Appeals & Grievances Coordinators (non-clinical professionals), the team works closely with Medical Directors, Case Managers, and Claims experts, creating a rich environment for learning and cross-functional engagement.. They’ll be reviewing member appeals, grievances, and provider disputes. The work is deeply impactful, as it directly affects the lives of Medicaid members. They will gain hands-on experience with state contracts, NCQA guidelines, and internal systems that are foundational to healthcare

Right to Hire - Billing/Claims/Appeals

$23/hr

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