Weekend Appeals & Grievances Operations Lead

Healthfirst; New York (NY); Hybrid; USD 103,000 - 149,000; Full time

Job summary

Healthfirst in New York seeks a Weekend Inventory Manager for Appeals & Grievances to lead weekend staff, plan assignments, and ensure compliant processing of appeals. You will coordinate with Medical Peer reviewers and other departments to support timely resolution.

The role requires HIPAA compliance, strong communication, and the ability to manage multiple priorities in a fast-paced environment. A weekend schedule is essential.

Qualifications

• High school diploma or GED required.
• Strong verbal and written communication skills.
• Ability to work weekends and manage multiple priorities.
• Experience with care management systems and routine use of standard software tools.

Responsibilities

• Prepare and plan weekend staff assignments and volume to ensure compliance.
• Triage and assign expedited appeals; help standardize routing of Appeals and Grievances.
• Manage inventory to ensure regulatory compliance for weekend appeals.
• Coordinate with outside departments for escalation and collaboration on appeal resolution.
• Maintain vendor relationships and monitor performance and compliance.

Skills

Verbal and written communication

Independent work style

Weekend schedule availability

HIPAA/compliance mindset

Education

H.S. Diploma or GED

Tools

Microsoft Word

Microsoft Excel

CCMS

TruCare

Hyland

Job description

Healthfirst in New York seeks a Weekend Inventory Manager for Appeals & Grievances to lead weekend staff, plan assignments, and ensure compliant processing of appeals. You will coordinate with Medical Peer reviewers and other departments to support timely resolution.

The role requires HIPAA compliance, strong communication, and the ability to manage multiple priorities in a fast-paced environment. A weekend schedule is essential.