Appeals & Grievances Coordinator II

MJHS; United States; On-site; USD 50,000 - 70,000; Full time

Benefits offered by this job

Tuition Reimbursement

Generous paid time off

Comprehensive medical coverage

403(b) and Employer Paid Pension

Flexible spending

Student Loan Forgiveness Program eligibility

Job summary

MJHS is seeking a dedicated coordinator to manage all non-clinical aspects of member and provider appeals. This role involves case processing, documentation, and coordination with clinical teams to ensure compliance with regulations.

Ideal candidates will have at least 2 years of appeals and grievances experience, knowledge of Medicare/Medicaid, and a diploma. The position offers comprehensive benefits and opportunities for professional growth.

Qualifications

• Minimum 2 years of Appeals and Grievances or Member Service experience required.
• Knowledge of Medicare or Medicaid is necessary.

Responsibilities

• Manage and process appeals and grievances with accuracy and compliance.
• Review cases and confirm proper classifications as necessary.
• Respond to appeals in a timely manner following regulatory guidelines.
• Document all relevant information accurately in the A/G system.

Skills

Member advocacy

Case management

Regulatory compliance

Documentation tracking

Education

Diploma

Job description

MJHS is seeking a dedicated coordinator to manage all non-clinical aspects of member and provider appeals. This role involves case processing, documentation, and coordination with clinical teams to ensure compliance with regulations.

Ideal candidates will have at least 2 years of appeals and grievances experience, knowledge of Medicare/Medicaid, and a diploma. The position offers comprehensive benefits and opportunities for professional growth.