Grievance & Appeals Specialist (Remote)

Banner Health; Arizona; Hybrid; USD 30,000 - 44,000; Full time

Job summary

Banner Health is seeking a Health Plans Grievance and Appeals Coordinator. The role focuses on intake, review, investigation, and resolution of grievances, appeals and provider disputes within Banner Plans & Networks. A high-volume, fast-paced environment requires prior knowledge of grievance processes and Arizona regulatory frameworks.

Primary remote work with must reside in Arizona; 8:00 a.m.–5:00 p.m. shift and Per Diem positions have no guaranteed hours.

Qualifications

• High school diploma/GED or equivalent working knowledge.
• Two years of work experience in health care related field or experience managing projects/initiatives, or an equivalent combination of education and experience.
• Knowledge of AHCCCS, HCG and/or CMS regulations. Knowledge of MS Word, Excel and Microsoft Office Suite required. Knowledge of Medical terminology, claims processing guidelines, and CRM & IDX. Knowledge of grievance, appeal and claim dispute processes.
• Strong interpersonal, organizational and problem solving skills. Strong oral and written communication skills required. Ability to work independently ensuring all deadlines/timelines are met and to work with various levels of healthcare professionals. Ability to be flexible and work on a variety of projects simultaneously under tight time constraints. Strong analytical, critical-thinking and time management skills. Strong organizational skills and ability to prioritize multiple tasks daily. Ability to quickly identify, summarize and present options to issues and to meet regulatory reporting requirements.

Responsibilities

• Determines which claim disputes meet acceptable claim dispute criteria and logs, categorizes and tracks all received documents.
• Enters appeals and claim disputes into the CRM; creates and maintains case files with review sheets.
• Ensures all appeals and claim disputes are acknowledged within regulatory timelines; facilitates input from internal/external stakeholders.
• Responds to incoming calls, researches and resolves questions on grievances, appeals and disputes; routes mail.
• Creates and submits resolution/extension correspondence following applicable statutes and codes; self-audits for compliance.
• Gathers medical records and documentation required for reviewers; handles special handling requirements.
• Reports at Grievance/Appeals meetings on incoming and scheduled hearings as appropriate.
• Works with other departments to facilitate timely responses; provides expertise on grievances/appeals.
• Works under supervision in a fast-paced, customer-focused environment and interfaces with staff at all levels.

Job description

Banner Health is seeking a Health Plans Grievance and Appeals Coordinator. The role focuses on intake, review, investigation, and resolution of grievances, appeals and provider disputes within Banner Plans & Networks. A high-volume, fast-paced environment requires prior knowledge of grievance processes and Arizona regulatory frameworks.

Primary remote work with must reside in Arizona; 8:00 a.m.–5:00 p.m. shift and Per Diem positions have no guaranteed hours.