Senior Grievance & Appeals Strategist

Medasource; Phoenix (AZ); On-site; USD 55,000 - 70,000; Full time

Job summary

Medasource in Arizona is seeking a Grievance & Appeals Specialist to maintain State Fair Hearing logs and coordinate with the Grievance & Appeals Manager for higher-level reviews. You will review requests, assemble case files, and support cross-department projects related to appeals.

The role also involves producing weekly/monthly data reports, assisting with audits, and delivering timely communications to members and providers in a fast-paced environment.

Qualifications

• Two years of work experience in a health care related field or experience managing projects/initiatives.
• Three to four years of grievance and appeal work in a health care environment, or an equivalent combination of education and experience. Maintains knowledge of AHCCCS, HCG, and CMS regulations by participating in training, teleconferences, and services.

Responsibilities

• Maintain State Fair Hearing Logs with information required by HP policy, AHCCCS, HCG, and CMS regulations.
• Review all State Fair Hearing requests by members and providers, pull case files, and coordinate with the Grievance & Appeals Manager for action.
• Coordinate and assist in preparing for higher levels of appeals (Independent Review Entity reviews, hearings, etc.).
• Assist with project management of departmental improvements; coordinate with other departments on Grievance & Appeals projects/workgroups.
• Assist the Marketing Department with production of member letters and notices; participate in meetings and committees relevant to the Grievance & Appeals process.
• Produce and analyze weekly and monthly data for trends, assist with audits, and maintain data validation.

Education

High school diploma/GED or equivalent

Job description

Medasource in Arizona is seeking a Grievance & Appeals Specialist to maintain State Fair Hearing logs and coordinate with the Grievance & Appeals Manager for higher-level reviews. You will review requests, assemble case files, and support cross-department projects related to appeals.

The role also involves producing weekly/monthly data reports, assisting with audits, and delivering timely communications to members and providers in a fast-paced environment.