Impactful Grievance & Appeals Coordinator

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 60,000 - 75,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island seeks a Grievance and Appeals Coordinator to support the GAU by managing intake, assignment, and tracking of appeals and grievances across all product lines. The role ensures timely, compliant correspondence to members and providers and monitors case progress.

You will handle external appeals, maintain secure records, train new staff, and collaborate across departments to maintain compliance, meeting deadlines and contributing to exceptional service.

Qualifications

• Associates degree or equivalent work experience.
• Strong analytical skills with ability to identify issues, collect data, and draw conclusions.
• Basic knowledge of medical terminology and CPT/ICD10 coding.
• Familiarity with state and federal laws related to grievances and appeals.
• Excellent organizational, prioritization, and time management skills.
• Strong customer service orientation and professional communication skills.

Responsibilities

• Intake and process Medicaid, Medicare, and Commercial appeals and grievances.
• Scan and convert paper submissions to electronic format for processing.
• Generate timely and compliant acknowledgement letters.
• Track and monitor all cases electronically with accurate documentation.
• Manage external appeals for Medicaid and Commercial lines and ensure containment of deadlines.
• Follow up with internal departments to ensure timely resolution.

Skills

Analytical skills

Medical terminology

CPT/ICD10 familiarity

Proficiency in Microsoft Office

Time management

Education

Associates degree or equivalent

Tools

Healthcare management systems

Proprietary platforms

Job description

Neighborhood Health Plan of Rhode Island seeks a Grievance and Appeals Coordinator to support the GAU by managing intake, assignment, and tracking of appeals and grievances across all product lines. The role ensures timely, compliant correspondence to members and providers and monitors case progress.

You will handle external appeals, maintain secure records, train new staff, and collaborate across departments to maintain compliance, meeting deadlines and contributing to exceptional service.