Medicare & Medicaid Grievance & Appeals Specialist

Neighborhood Health Plan of Rhode Island; Smithfield (RI); Sur place; USD 45 000 - 65 000; Plein temps

Résumé du poste

Neighborhood Health Plan of Rhode Island is seeking a Grievance and Appeals Coordinator to manage intake of grievances and appeals, and to mail correspondences to members and providers. The role supports GAU through tracking cases and ensuring timely resolutions.

The Coordinator monitors timelines, coordinates with external appeal agencies, and maintains secure, organized records while communicating with internal and external customers.

Qualifications

• Associates degree or equivalent experience.
• Strong problem identification and data analysis skills.
• Basic knowledge of medical terminology and CPT/ICD-9/10.
• Familiarity with state and federal healthcare laws.
• Strong prioritization and time management abilities.
• Excellent customer service and phone etiquette.

Responsabilités

• Handle intake of Medicaid, Medicare, and Commercial grievances and appeals.
• Scan and route grievances into the electronic system for processing.
• Generate initial member acknowledgments in a timely manner.
• Track and attach documents to member records.
• Oversee external appeals for Medicaid and commercial lines.
• Collaborate with departments to ensure timely, compliant resolutions.

Connaissances

Customer service

Time management

Interpersonal skills

Attention to detail

Microsoft Office

Verbal communication

Formation

Associates Degree

Relevant work experience

CPC certification

Outils

EMR/EHR systems

CMS knowledge

Excel

Description du poste

Neighborhood Health Plan of Rhode Island is seeking a Grievance and Appeals Coordinator to manage intake of grievances and appeals, and to mail correspondences to members and providers. The role supports GAU through tracking cases and ensuring timely resolutions.

The Coordinator monitors timelines, coordinates with external appeal agencies, and maintains secure, organized records while communicating with internal and external customers.