Appeals & Grievance Coordinator

AllCare Health, Inc.; Grants Pass (OR); On-site; USD 31,684 - 34,440; Full time

Benefits offered by this job

Affordable healthcare

401k retirement

Wellness programs

Flexible schedule

Job summary

AllCare Health in Grants Pass, Oregon, seeks an Appeals & Grievance Coordinator to process and resolve member and provider appeals and grievances within the Quality department.

You will investigate complex cases, coordinate with medical directors, DMAP, CMS, and independent review entities, and prepare complete case files for processing. This on-site role requires knowledge of enrollment, claims, and provider disputes.

Qualifications

• AA from a two-year college or university or 1–2 years related experience.
• Certified Professional Coder (CPC) strongly preferred.
• On-site work required for all scheduled shifts.

Responsibilities

• Investigates and resolves complex member and provider complaints related to enrollment and claims, provider payment disputes, medical appeals, and reversals.
• Provides the medical director with a complete case file for processing of the appeals and grievances and coordinates care or payment of services.
• Forwards appeals to CMS Independent Review Entity or to DMAP for further review.
• Collaborates with DMAP, CMS, or the independent review entity for review.

Education

Associate's degree (AA)

Job description

AllCare Health Headquarters, Grants Pass, OR, US

7 days ago Requisition ID: 1214

Salary Range: $23.00 To $25.00 Hourly

Appeals & Grievance Coordinator at AllCare Health with the Quality department in Grants Pass, Oregon

We Are Seeking Qualified Candidates to Join Our Team!

AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.

Summary

This position is responsible for processing and resolving the Oregon Health Plan and Advantage Health Plan members and provider appeals and grievances by performing the following duties.

Essential Duties

• Investigates and resolves complex member and provider complaints related to enrollment and claims, provider payment disputes, medical appeals, and reversals within the health care industry.
• Provides the medical director with a complete case file for processing of the appeals and grievances and coordinates care or payment of services.
• Forwards appeals to CMS Independent Review Entity or to DMAP for further review.
• Collaborates with DMAP, CMS, or the independent review entity for review.

All relevant experience can be listed in your resume to perform essential duties of the position including the following: lived, volunteer, professional, or a combination of experience and education.

Job Requirements

• May require the use of personal vehicle for local travel (subject to mileage reimbursement).

Education & Experience

• Associate's degree (AA) from a two-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.

Certificates, Licenses and/or Registrations

• Certified Professional Coder (CPC) is strongly preferred.

Physical Demands & Work Environment

The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The noise level in the work environment is usually moderate. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

• The employee must be able to work on-site for all scheduled shifts.

Company Overview

AllCare Health Website: https://www.allcarehealth.com .

AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp® status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps athttps://bcorporation.net/about-b-corps )

AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.

The AllCare Health family of businesses is guided by our corporate principles:

Purpose

Working together with our communities to improve the health and well-being of everyone.

Values

Trust, Innovation, Relationships, and Voice.

Vision

Thriving, Inclusive, and Equitable communities.

Brand Promise

Changing Healthcare to Work for You.

AllCare Health is dedicated to building a diverse and authentic workplace centered in belonging and serving our growing community.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.

Monday - Friday; 8:00am - 5:00pm w/ a 1 hour unpaid lunch & two 15 minute paid breaks
40 hours per week