Appeals & Grievance Coordinator

Acentra Health, LLC; Augusta (ME); Remote; USD 40,000 - 52,000; Full time

Job summary

Acentra Health, LLC is seeking an Appeals & Grievance Specialist for our growing team. The role focuses on researching and investigating to resolve complaints and appeals, overseeing outcomes, and ensuring prompt completion of the process.

This position is remote with core hours in the Eastern Time Zone. Responsibilities include triage, correspondence with members and providers, and maintaining case documentation in accordance with HIPAA and related policies.

Qualifications

• Requires high school diploma or GED.
• Associate's degree preferred.
• 1+ years experience in customer service required.

Responsibilities

• Assign mail cases to the correct area based on the level of appeal (admin, clinical, external for triage).
• Verbal and written correspondence, such as acknowledgment letters, to members, providers, and regulatory agencies.
• Document and log inquiry, appeal, and complaint information.
• Resolve cases within the necessary time to meet the turnaround time.
• Ensure proper resolution of inquiries, grievances, and appeals within regulatory or accreditation timelines or customer needs.
• Read, understand, and adhere to all corporate policies including HIPAA rules.

Skills

Customer service

Interpersonal skills

Critical thinking

Organizational skills

Written and verbal communication

Education

High school diploma or GED

Associate's degree preferred

Tools

MS Word

Outlook

Job description

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.At Acentra Health, we embrace emerging technologies, including artificial intelligence and advanced analytics that can be utilized to improve processes, enhance decision-making, and drive better health outcomes. We value professionals who are curious about new technologies and motivated to use innovative tools to increase efficiency, quality, and impact in their roles.

Job Summary and Responsibilities

Acentra Health is looking for a Appeals & Grievance Specialist to join our growing team.

Job Summary

The Appeals and Grievance Specialist is responsible for conducting thorough research andinvestigations to aid in resolving complaints and appeals. The Appeals and Grievance Specialistwill oversee and manage the outcomes, ensuring a seamless and prompt completion of thecomplaints and appeals process.

This is remote with core hours in the eastern time zone.

Responsibilities

• Assign mail cases to the correct area based on the level of appeal, such as admin appeal, clinical, or external for the triage department.
• Verbal and written correspondence, such as acknowledgment letters, to customers such as members, providers, and regulatory agencies.
• Document and log inquiry, appeal, and complaint information.
• Resolve cases within the necessary time to meet the turnaround time.
• Ensure proper resolution of inquiries, grievances, and appeals within the specified times established by regulatory or accreditation agencies or customer needs.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
• The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

Required Qualifications

• Requires high school diploma or GED.
• Associate's degree preferred1+years' experience in customer service required.
• Previous experience in the health care industry preferred.

Preferred Qualifications

• Proficient in using MS Word, Outlook, and other relevant software.
• Possess strong critical thinking capabilities.
• Exhibit flexibility and good organizational skills.
• Demonstrate outstanding interpersonal skills.
• Basic data entry skills.
• Display excellent customer service skills.
• Able to meet departmental standards.
• Ability to review cases and ensure that they are set up for the correct level of appeal.
• Capable of researching and resolving the outcomes of complaints.
• Demonstrate the ability to collaborate effectively in a collaborative environment.
• Possess excellent written and verbal communication skills.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations