Bilingual Appeals & Grievances Coordinator II

LEON Health, Inc.; Florida; On-site; USD 55,000 - 75,000; Full time

Job summary

LEON Health, Inc. is seeking an Appeals and Grievance Coordinator to research and resolve complex issues related to members' healthcare, account status, and plan options.

You will manage enrollment and billing activities, navigate multiple databases, and communicate with compassion while handling multiple systems. This role emphasizes accuracy, timeliness, and collaboration with cross-functional teams to improve member experience.

Qualifications

• Two (2) years' experience working in a managed care environment in grievance or appeals.
• Experience with claims or related areas is acceptable.

Responsibilities

• Coordinates intake of appeal and grievance requests into designated systems.
• Generates acknowledgement letters and answers status questions.
• Compiles case files for Independent Review Entity (IRE).
• Ensures compliance with state and federal regulatory timeframes for handling cases.
• Prepares case files for IRE or escalated cases, including statements of position.
• Develops grievance and appeal information from designated databases.
• Assists Investigation and Appeals Specialists with resolutions.
• Maintains positive customer relations and coordinates with various functions within the company.
• Demonstrates courtesy and professionalism to patients, visitors, and staff.

Skills

Bilingual English/Spanish

Education

Bachelor's degree in business or related field

Job description

LEON Health, Inc. is seeking an Appeals and Grievance Coordinator to research and resolve complex issues related to members' healthcare, account status, and plan options.

You will manage enrollment and billing activities, navigate multiple databases, and communicate with compassion while handling multiple systems. This role emphasizes accuracy, timeliness, and collaboration with cross-functional teams to improve member experience.