Weekend Appeals & Grievances Inventory Lead

HealthFirst; United States; Remote; USD 103,000 - 149,000; Full time

Benefits offered by this job

Medical, Dental & Vision Coverage

Life Insurance

401k Contributions

Job summary

Healthfirst is seeking a Weekend Inventory Manager for Appeals & Grievances to oversee weekend inventory and assignments for the A&G Clinical Specialist team. This full-time role requires weekend availability (Fri-Mon or Thurs-Sun) and a four-day schedule.

You will collaborate with leaders to drive production, quality and regulatory compliance, balancing strategic priorities with staffing needs to support Healthfirst's growth and profitability goals.

Qualifications

• H.S. Diploma or GED required.
• Experience with appeals and grievances or healthcare setting.
• Strong verbal and written communication.
• Ability to handle multiple priorities and work independently.
• Weekend schedule availability (Fri-Mon or Thurs-Sun).
• Proficiency with Word, Excel, email, and care management systems (CCMS, TruCare, Hyland).

Responsibilities

• Prepare and plan weekend staff assignments to ensure compliance.
• Triage and assign expedited appeals and optimize routing.
• Manage inventory to ensure regulatory compliance for weekend appeals.
• Communicate and escalate cases to Medical Peer reviewers.
• Maintain vendor relationships and monitor performance and compliance.
• Coordinate with outside departments for escalation and collaboration.
• Oversee letter review and printing and coordinate with the mailroom.
• Review change requests and follow-up routing.
• Submit Level 2 appeals packets to the appropriate entity.
• Stay updated on industry trends and best practices.
• Identify trends and recommend improvements.
• Build partnerships across operations to improve responsiveness.
• Provide feedback to leadership on staff performance.
• Comply with HIPAA and maintain confidentiality.
• Adhere to state and federal guidelines.
• Perform additional duties as assigned.

Skills

Verbal communication

Written communication

Fast-paced environment

Multitasking

Weekend availability

Education

H.S. Diploma or GED

Bachelor’s degree

Tools

CCMS

TruCare

Hyland

Microsoft Word

Excel

Job description

Healthfirst is seeking a Weekend Inventory Manager for Appeals & Grievances to oversee weekend inventory and assignments for the A&G Clinical Specialist team. This full-time role requires weekend availability (Fri-Mon or Thurs-Sun) and a four-day schedule.

You will collaborate with leaders to drive production, quality and regulatory compliance, balancing strategic priorities with staffing needs to support Healthfirst's growth and profitability goals.