Appeals & Grievance Coordinator

Acentra Health; Portland (ME); Remote; USD 28,000 - 35,000; Full time

Job summary

Acentra Health is seeking an Appeals & Grievance Specialist to conduct investigations and manage outcomes of complaints and appeals. This remote role follows core hours in the Eastern time zone, with responsibilities including triage, correspondence, documentation, and timely resolution in compliance with regulatory and accreditation requirements.

The ideal candidate has a history in customer service, strong communication, and the ability to collaborate in a team-oriented environment, while

Qualifications

• Requires high school diploma or GED; Associate's degree preferred.
• 1+ years' experience in customer service required.
• Proficient in MS Word and Outlook; strong written and verbal communication skills.
• Strong critical thinking, organization, and interpersonal abilities.
• Ability to review cases and ensure correct level of appeal and collaborate effectively.

Responsibilities

• Assign mail cases to the correct area based on appeal level.
• Respond to customers via verbal and written correspondence.
• Document and log inquiry, appeal, and complaint information.
• Resolve cases within required timeframes to meet turnaround deadlines.
• Adhere to HIPAA and privacy/security policies.

Skills

Customer service

Communication

Organizational skills

Interpersonal skills

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 and investigations to aid in resolving complaints and appeals. The Appeals and Grievance Specialist will oversee and manage the outcomes, ensuring a seamless and prompt completion of the complaints 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 preferred
• 1+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 for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Compensation

The pay for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."\

Pay Range

USD $20.42 - USD $25.53 /Hr.