Remote Appeals & Grievance Specialist

Acentra; Maine; Remote; USD 28,000 - 35,000; Full time

Job summary

Acentra Health is seeking an Appeals & Grievance Specialist to join our growing team. The role focuses on research and investigations to aid in resolving complaints and appeals, overseeing outcomes, for a seamless completion of the process.

This remote position uses Eastern Time core hours and requires managing mail cases, correspondence with members, providers, and regulators, and thorough documentation to ensure timely, compliant resolutions.

Qualifications

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

Responsibilities

• Assign mail cases to the correct area based on the level of appeal, such as admin appeal, clinical, or external for the triage department.
• Verbal and written correspondence, such as acknowledgment letters, to customers such as 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 the specified timesestablished by regulatory or accreditation agencies or customer needs.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Skills

Customer service

Critical thinking

Interpersonal skills

Written communication

Organizational skills

Flexibility

Team collaboration

Data entry

Excellent customer service

Education

High school diploma or GED

Associate's degree preferred

Tools

MS Word

Outlook

Job description

Acentra Health is seeking an Appeals & Grievance Specialist to join our growing team. The role focuses on research and investigations to aid in resolving complaints and appeals, overseeing outcomes, for a seamless completion of the process.

This remote position uses Eastern Time core hours and requires managing mail cases, correspondence with members, providers, and regulators, and thorough documentation to ensure timely, compliant resolutions.