Lead Grievance & Appeals Coordinator

Cenetene Corporation; Phoenix (AZ); Remote; USD 80,000 - 100,000; Full time

Job summary

An innovative organization is seeking an Appeals and Health Services Coordinator to lead the daily operations of the appeals function. This role involves ensuring compliance with internal standards, training staff, and preparing for audits. The ideal candidate will have a strong background in grievance and appeals management, as well as experience in healthcare settings. With a commitment to diversity and a flexible work environment, this position offers a unique opportunity to make a significant impact on the lives of millions. If you're passionate about improving health services and have the skills to drive performance, this role could be your next career step.

Benefits

Health Insurance

401(k) Plan

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• 2+ years of experience in grievance and appeals in healthcare.
• Prior claims and leadership experience preferred.

Responsibilities

• Consult on problem resolution and monitor team output.
• Train and educate team members on processes and policies.
• Prepare for audits and compile necessary documentation.

Skills

Grievance and Appeals Management

Problem Resolution

Training and Education

Audit Preparation

Process Improvement

Education

Bachelor's Degree in a Related Field

Job description

Job Title: Appeals and Health Services Coordinator

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits and a flexible workplace environment.

Location:

Position is remote. Travel to the Tempe, AZ office may be necessary.

Position Purpose:

Provide support and direction for the daily operations of the appeals function.

Responsibilities:

1. Provide consultation for problem resolution for appeals staff and monitor team work output to ensure compliance with internal and NCQA standards.
2. Identify training, process improvement, and resource needs to maximize team performance and recommend action plans to management.
3. Review denial and appeal letters as needed to ensure appropriate content and messaging.
4. Prepare for state/health plan audits, respond to complaints, and compile documentation for state fair hearings.
5. Prepare monthly reports, logs, and meet other health plan or state contractual requirements.
6. Review and monitor team workload and output to ensure efficiency and accuracy.
7. Serve as the point of contact for issues raised by members, providers, and internal teams.
8. Train and educate new and existing team members on processes, policies, procedures, and market requirements.

Qualifications:

Bachelor’s degree in a related field or equivalent experience. At least 2 years of grievance and appeals experience in a healthcare or managed care setting. Prior claims and leadership experience are preferred.

Additional Information:

Pay Range: $22.79 - $38.84 per hour.

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off and holidays, and flexible work arrangements (remote, hybrid, field, or office).

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Applicants with arrest or conviction records will be considered in accordance with applicable laws.