Remote Appeals & Grievance Specialist

Acentra Health, LLC; Augusta (ME); Remote; USD 40,000 - 52,000; Full time

Job summary

Acentra Health, LLC is seeking an Appeals & Grievance Specialist for our growing team. The role focuses on researching and investigating to resolve complaints and appeals, overseeing outcomes, and ensuring prompt completion of the process.

This position is remote with core hours in the Eastern Time Zone. Responsibilities include triage, correspondence with members and providers, and maintaining case documentation in accordance with HIPAA and related policies.

Qualifications

• Requires high school diploma or GED.
• Associate's degree preferred.
• 1+ years experience in customer service required.

Responsibilities

• Assign mail cases to the correct area based on the level of appeal (admin, clinical, external for triage).
• Verbal and written correspondence, such as acknowledgment letters, to members, providers, and regulatory agencies.
• Document and log inquiry, appeal, and complaint information.
• Resolve cases within the necessary time to meet the turnaround time.
• Ensure proper resolution of inquiries, grievances, and appeals within regulatory or accreditation timelines or customer needs.
• Read, understand, and adhere to all corporate policies including HIPAA rules.

Skills

Customer service

Interpersonal skills

Critical thinking

Organizational skills

Written and verbal communication

Education

High school diploma or GED

Associate's degree preferred

Tools

MS Word

Outlook

Job description

Acentra Health, LLC is seeking an Appeals & Grievance Specialist for our growing team. The role focuses on researching and investigating to resolve complaints and appeals, overseeing outcomes, and ensuring prompt completion of the process.

This position is remote with core hours in the Eastern Time Zone. Responsibilities include triage, correspondence with members and providers, and maintaining case documentation in accordance with HIPAA and related policies.