Grievance & Appeals Coordinator I.

Pyramid Consulting, Inc; Georgia (VT); Remote; USD 30,307 - 30,996; Full time

Benefits offered by this job

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave

Job summary

A leading healthcare consulting firm is seeking a Grievance & Appeals Coordinator I for a contract role. Responsibilities include managing member appeals, ensuring compliance with CMS guidelines, and maintaining a high productivity benchmark. Candidates need a high school diploma and 1+ year experience in Grievance & Appeals. The job offers competitive pay and requires strong analytical skills with regulatory knowledge.

Qualifications

• At least 1+ years’ experience with Grievance & Appeals.
• Formal written communication; accuracy with data entry.
• Experience in a production environment.

Responsibilities

• Acknowledge and resolve member appeals within established turnaround times.
• Ensure regulatory compliance by managing time-sensitive member appeals.
• Maintain or exceed 98% compliance rate for all appeal files.

Skills

Regulatory knowledge (CMS, Medicaid, NCQA)

Prioritization and time management skills

Interpersonal skills

Technology proficiency

Education

High school diploma or equivalent

Job description

Base pay range

$22.00/hr - $22.50/hr

Immediate need for a talented Grievance & Appeals Coordinator I. This is a 03+ Months Contract opportunity with long-term potential and is located in GA (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-81598

Pay Range: $22 - $22.50/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities

• The workday is spent acknowledging and resolving member appeals within established turnaround times. Member facing team but providers may reach out to request appeals on members behalf.
• Appeals mainly via fax but may come through phone or email
• Maintain or exceed 98% compliance rate for all appeal files while meeting daily productivity benchmark of 8-10 cases per day based on the volume.
• This role ensures regulatory compliance by managing time-sensitive member appeals in accordance with CMS and state guidelines.
• It requires deep knowledge of managed care processes, strong analytical and communication skills, and the ability to coordinate across departments to resolve complex issues impacting member care and health plan operations.

Key Requirements and Technology Experience

• Formal written communication; accuracy with data entry and tracking/ independent work.
• Prioritization and time management skills.
• Regulatory knowledge (CMS, Medicaid, NCQA).
• High school diploma or equivalent.
• At least 1+ years’ experience with Grievance & Appeals. Regulatory knowledge (CMS, Medicaid, NCQA).
• Previous grievance and appeals or UM prior authorization experience, regulatory knowledge, critical thinking/problem solving with independent work, organizational skills, adaptability, and professionalism.
• This is a production environment. Interpersonal skills. Technology proficiency.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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Job Details

• Seniority level: Not Applicable
• Employment type: Contract
• Job function: Health Care Provider
• Industries: Hospitals and Health Care