Remote Member Complaints & Grievances Coordinator I

UPMC; Pittsburgh (Allegheny County); Remote; USD 42,000 - 64,000; Full time

Job summary

UPMC Health Plan is seeking a Member Complaints & Grievances Coordinator I to manage member grievances, appeals, and IRE requests for Medicare and SNP lines. This full-time, daylight-hours role is remote and requires organizing tasks within regulatory timeframes and composing professional letters for members.

Qualifications include an associate degree or equivalent experience, at least 1 year in a healthcare setting, and familiarity with ICD-10, HCPCS, and CPT4 coding.

Qualifications

• Excellent verbal and written presentation skills.
• Familiarity with ICD-10, HCPCS, and CPT4 coding and medical terminology.
• PC literacy with proficiency in Microsoft Office products.

Responsibilities

• Investigate member complaints and grievances, and provider appeals, and respond in writing according to department standards.
• Effectively utilize key internal and external Health Plan contacts to help in this process.
• Organize all tasks within regulatory requirements/deadlines.
• Ensure member and provider concerns are thoroughly and accurately addressed according to regulatory guidelines.
• Understand and interpret medical information, recognize trends, and identify opportunities for improvement within the Health Plan.
• Prepare Independent Review Entity case files dependent online of Business.
• Assist in reporting complaint and grievance data to appropriate regulatory bodies and internal departments.
• Maintain quality and performance metrics as outlined by Supervisor.
• Constructs IRE Packets as needed.

Skills

Verbal communication

Written communication

Microsoft Office

Medical coding familiarity

Healthcare experience

Education

Associate degree or equivalent

Job description

UPMC Health Plan is seeking a Member Complaints & Grievances Coordinator I to manage member grievances, appeals, and IRE requests for Medicare and SNP lines. This full-time, daylight-hours role is remote and requires organizing tasks within regulatory timeframes and composing professional letters for members.

Qualifications include an associate degree or equivalent experience, at least 1 year in a healthcare setting, and familiarity with ICD-10, HCPCS, and CPT4 coding.