Grievance & Appeals Coordinator I
Arizona Complete Health, Tempe, AZ, United States
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Location
In office role, Monday - Friday, 8AM to 5PM.
Position Purpose
Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
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
Perform other duties as assigned
Comply with all policies and standards
Education/Experience
High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims, related managed care experience or relevant experience.
Pay Range
$19.43 - $32.98 per hour
Benefits
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education and other job‑related factors permitted by law, including full‑time or part‑time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Equal Opportunity Employer
Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
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Location
In office role, Monday - Friday, 8AM to 5PM.
Position Purpose
Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
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
Perform other duties as assigned
Comply with all policies and standards
Education/Experience
High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims, related managed care experience or relevant experience.
Pay Range
$19.43 - $32.98 per hour
Benefits
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education and other job‑related factors permitted by law, including full‑time or part‑time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Equal Opportunity Employer
Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
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