Lead Grievance & Appeals Coordinator

Arizona Complete Health; Tempe (AZ); Hybrid; USD 80,000 - 100,000; Full time

Job summary

An innovative healthcare organization is seeking a Lead Grievance & Appeals Coordinator to enhance the efficiency of its appeals function. This role is crucial for ensuring compliance with internal standards and improving team performance. You will provide support, training, and direction to the appeals staff while preparing for audits and managing member interactions. With a focus on problem resolution and process improvement, this position offers a unique opportunity to make a significant impact in the healthcare sector. Join a dynamic team that values collaboration and flexibility in a remote work environment.

Benefits

Health Insurance

401K

Tuition Reimbursement

Paid Time Off

Flexible Work Schedule

Stock Purchase Plans

Qualifications

• Bachelor’s degree in a related field or equivalent experience.
• 2+ years of grievance and appeals experience in a Healthcare setting.

Responsibilities

• Provide support for daily operations of the appeals function.
• Train and educate team members on processes and policies.
• Prepare for state audits and monitor team workload.

Skills

Grievance Management

Appeals Coordination

Problem Resolution

Team Leadership

Healthcare Compliance

Education

Bachelor's Degree in Related Field

2+ Years Healthcare Experience

Job description

Join to apply for the Lead Grievance & Appeals Coordinator role at Arizona Complete Health.

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, including a fresh perspective on workplace flexibility.

Location: Position is remote. However, travel to the Tempe, AZ office may be necessary.

Position Purpose

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

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 message.
4. Prepare for state/health plan audits, responses to complaints, and requests for state fair hearing documentation.
5. Prepare monthly reports, logs, and other health plan or state contractual requirements.
6. Review and monitor team workload and output to ensure optimum efficiency and accuracy.
7. Serve as the point of contact for issues that arise from members, providers, and internal teams.
8. Train and educate new and existing team members on processes, policies, procedures, and contract or market requirements.

Education/Experience

Bachelor’s degree in a related field or equivalent experience. 2+ years of grievance and appeals experience in a Healthcare or Managed Care setting.

• Claims and prior leadership experience are preferred.

Location: Position is remote. However, travel to the Tempe, AZ office may be necessary.

Pay Range: $22.79 - $38.84 per hour.

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office schedules. Actual pay will be adjusted based on skills, experience, education, and other factors. Total compensation may include additional incentives.

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. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

Additional Information

• Seniority level: Not Applicable

• Employment type: Full-time

• Job function: Health Care Provider

• Industries: Hospitals, Healthcare, Insurance

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