Lead Grievance & Appeals Coordinator at Centene

You're a professional with at least two years of experience in grievance and appeals within healthcare or managed care, holding a Bachelor's degree in a related

Work type: remote

Location: Remote-MO | Remote-FL | Remote-CA

Salary: $23 – $40/hr

Type: Full-time

Summary

You're a professional with at least two years of experience in grievance and appeals within healthcare or managed care, holding a Bachelor's degree in a related field or equivalent experience. **What makes it worth a look...** Centene is offering a fully remote Lead Grievance & Appeals Coordinator role with pay ranging from $23.23 to $39.61 per hour. **You might be a good fit if you...** * Have 2+ years of grievance and appeals experience in Healthcare or Managed Care. * Can mentor staff and provide real-time feedback. * Are experienced in researching and resolving complex issues, including regulatory and CMS matters. * Can partner across departments to solve problems.

Job Description

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.
 

Key Responsibilities

• Handle escalated member and provider issues


• Mentor staff and give real-time feedback


• Serve as team SME


• Support workflow and productivity


• Help drive team goals


• Research and resolve complex issues, including regulatory and CMS matters


• Identify root causes and present solutions


• Track, document, and follow up on issues


• Partner across departments to solve problems


• Support team training and procedure updates


• Deliver a high-quality customer experience


• Respond to state and market inquiries


• Assist with intake work and special projects

• Medicare Intake Appeals Team

• Monday-Friday, 8:00 a.m.-5:00 p.m.


• Weekend rotation required

• Provide consultation for problem resolution for appeals staff and monitor team work output to ensure compliance with internal and NCQA standards


• Identify training, process improvement and resource needs to maximize team performance and recommend action plans to management


• Review denial and appeal letters as needed to ensure appropriate content and message


• Prepare for state/health plan audits, response to complaints and request for state fair hearing documentation


• Prepare monthly reports, logs, and other health plan or state contractual requirements


• Review and monitor team workload and output to ensure optimum efficiency and accuracy


• Serve as the point of contact for issues that arise from members, providers and internal team


• Train and educate new and existing team on processes, policies and procedures, and contract or market requirements


• Performs other duties as assigned


• Complies with all policies and standards

2+ years of grievance and appeals experience in a Healthcare or Managed Care setting.

Pay Range: $23.23 - $39.61 per hour

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.

View this job on nocollar jobs