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<div class="WordSection1">HCS Job Title: Grievance & Appeals Coordinator 
Company Job Title: Grievance & Appeals Coordinator I 
 
 
Working with TA Jordan Smith 
 
Vaccination NOT REQUIRED  
# of Openings:  2 
 
If Contract, Length of Assignment:  3 months 
MU or BR:  60% MU 
Compensation Notes:  $22 to $22 an hour 
Location:  Remote in WA 
Shift: M-F 8-5 
Start Date: ASAP 
Interview Times/Interviewer: Virtual with HM 
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;">1+ year of healthcare experience - preferably in grievance, appeals, claims or denials but call center from MCO background would work too
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 0.0in 0.5in;">Data entry skills
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 0.0in 0.5in;">Proficiency in Excel
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt 0.5in;">HS Diploma or GED
</ul>
Soft Skills Required:

<ul>
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 0.0in 0.5in;">Good written communication skills
	<li style="margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt 0.5in;">Ability to work independently, please specify if any positions on resume were remote
</ul>
 
Types of Candidates to Submit to Sales Rep: 
Best Candidate: Grievance and Appeals Coordinator with 2+ years of recent experience from MCO setting 
Second Best Candidate: Denials or Claims Specialist with 2+ years of recent experience from MCO setting 
Third Best Candidate:  CSR/MSR with 2+ years of recent experience from MCO setting 
 
 
Day to Day Duties: 
The focus for the position will be solely on post payment appeals, not member appeals. 
 
Provides basic grievance and appeals guidance and support to a limited number of providers. 
Resolve grievances and appeals, which includes:

<ul>
	<li style="margin-top: 0.0in;margin-right: 0.0in;margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt;">Sending the appropriate acknowledgement of the grievance/appeal; Providing education about the grievance/appeal process and the right to appeal to state or federal agencies (if applicable);
	<li style="margin-top: 0.0in;margin-right: 0.0in;margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt;">Gathering all pertinent and relevant information regarding the grievance/appeal, determining the appropriate resolution of the grievance/appeal per standard policies and procedures; and
	<li style="margin-top: 0.0in;margin-right: 0.0in;margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt;">Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue.
	<li style="margin-top: 0.0in;margin-right: 0.0in;margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt;">Conducts non-biased, accurate, timely and comprehensive investigation of all the facts related to the grievance/appeal.
	<li style="margin-top: 0.0in;margin-right: 0.0in;margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt;">Thoroughly documents all action taken on behalf to resolve the grievance/appeal.
	<li style="margin-top: 0.0in;margin-right: 0.0in;margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt;">Ensures that all grievances/appeals are processed in adherence to state and federal regulations, contractual obligations, NCQA guidelines and Plan policy.
	<li style="margin-top: 0.0in;margin-right: 0.0in;margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt;">Prepares clear, objective, accurate and comprehensive case histories.
	<li style="margin-top: 0.0in;margin-right: 0.0in;margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt;">Maintains accurate and timely documentation, including complete files of all grievances/appeals.
	<li style="margin-top: 0.0in;margin-right: 0.0in;margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt;">Non-Exempt - Reporting to work on time and for all scheduled shifts is essential to this position.
	<li style="margin-top: 0.0in;margin-right: 0.0in;margin-bottom: 0.0in;margin: 0.0in 0.0in 8.0pt;">Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
</ul>
</div>

Billing/Claims/Appeals

$22/hr

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