Remote Grievance & Appeals Specialist

Banner Health; Yuma (AZ); A distancia; USD 30.000 - 44.000; Jornada completa

Descripción de la vacante

Banner Plans & Networks in Arizona seeks a Grievance and Appeals Coordinator to manage the intake, review, investigation, and resolution of member grievances, appeals, and provider disputes in a remote setting.

Candidates must reside in Arizona; you will document findings, coordinate with internal teams, and prepare professional correspondence while meeting regulatory timelines and providing accurate, timely resolutions.

Formación

• High school diploma or equivalent; 2 years healthcare or project management experience.
• Knowledge of AHCCCS, HCG, CMS regulations.
• Proficient in MS Word, Excel, Microsoft Office.
• Strong communication, organizational and problem-solving skills.

Responsabilidades

• Determine which claim disputes meet criteria and maintain logs.
• Enter accepted appeals into CRM and maintain case files.
• Ensure all appeals are acknowledged within regulatory timelines.
• Respond to inquiries by phone; route mail and respond to requests.
• Prepare resolution correspondence citing regulatory policies and statutes.
• Gather medical records and assist reviewers with grievances and appeals.

Conocimientos

Communication skills

Regulatory knowledge

CRM knowledge

Attention to detail

Time management

Educación

High school diploma/GED

Herramientas

Microsoft Office

CRM systems

IDX knowledge

Descripción del empleo

Banner Plans & Networks in Arizona seeks a Grievance and Appeals Coordinator to manage the intake, review, investigation, and resolution of member grievances, appeals, and provider disputes in a remote setting.

Candidates must reside in Arizona; you will document findings, coordinate with internal teams, and prepare professional correspondence while meeting regulatory timelines and providing accurate, timely resolutions.