Remote Grievance & Appeals Specialist

bannerhealth; Arizona; On-site; USD 28,000 - 41,000; Full time

Job summary

Banner Health Staffing Services-AZ is seeking a Health Plans Grievance and Appeals Coordinator to oversee intake, review, investigation and resolution of grievances, appeals, and provider disputes. This high-volume, fast-paced role requires knowledge of grievance and appeals processes and strong attention to detail.

Remote work option is available; candidates must reside in Arizona. Shifts are 8:00 a.m.–5:00 p.m., Monday–Friday, with emphasis on timely documentation and collaboration across

Qualifications

• High school diploma/GED or equivalent working knowledge.
• Two years of work experience in health care related field or experience managing projects/initiatives, or an equivalent combination of education and experience.
• Knowledge of AHCCCS, HCG and CMS regulations; proficiency with MS Word, Excel and Microsoft Office Suite.

Responsibilities

• Determine which claim disputes meet criteria and respond appropriately; assist in resolving member questions to reduce formal grievances.
• Enter appeals and disputes into CRM; maintain case files and review sheets for Medical/Claim Review.
• Ensure timely acknowledgments within regulatory timelines and protect confidentiality of member information.
• Respond to inquiries via phone and mail; route or respond to grievances, appeals and disputes.
• Create and submit resolution correspondence using applicable statutes and regulations; self-audit for compliance.

Skills

Interpersonal skills

Organizational skills

Problem solving

Written communication

Time management

Analytical thinking

CRM knowledge

Microsoft Office

Education

High school diploma/GED

Tools

CRM & IDX

MS Word & Excel

Job description

Banner Health Staffing Services-AZ is seeking a Health Plans Grievance and Appeals Coordinator to oversee intake, review, investigation and resolution of grievances, appeals, and provider disputes. This high-volume, fast-paced role requires knowledge of grievance and appeals processes and strong attention to detail.

Remote work option is available; candidates must reside in Arizona. Shifts are 8:00 a.m.–5:00 p.m., Monday–Friday, with emphasis on timely documentation and collaboration across