[Hiring] Appeals & Grievance Coordinator @Acentra Health, LLC

Role Description

Acentra Health is looking for an Appeals & Grievance Specialist to join our growing team. The Appeals and Grievance Specialist is responsible for conducting thorough research and investigations to aid in resolving complaints and appeals. The Appeals and Grievance Specialist will oversee and manage the outcomes, ensuring a seamless and prompt completion of the complaints and appeals process. This is remote with core hours in the eastern time zone.

• Assign mail cases to the correct area based on the level of appeal, such as admin appeal, clinical, or external for the triage department.
• Verbal and written correspondence, such as acknowledgment letters, to customers such as members, providers, and regulatory agencies.
• Document and log inquiry, appeal, and complaint information.
• Resolve cases within the necessary time to meet the turnaround time.
• Ensure proper resolution of inquiries, grievances, and appeals within the specified times established by regulatory or accreditation agencies or customer needs.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
• The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

• Requires high school diploma or GED.
• Associate's degree preferred.
• 1+ years' experience in customer service required.
• Previous experience in the health care industry preferred.

Requirements

• Proficient in using MS Word, Outlook, and other relevant software.
• Possess strong critical thinking capabilities.
• Exhibit flexibility and good organizational skills.
• Demonstrate outstanding interpersonal skills.
• Basic data entry skills.
• Display excellent customer service skills.
• Able to meet departmental standards.
• Ability to review cases and ensure that they are set up for the correct level of appeal.
• Capable of researching and resolving the outcomes of complaints.
• Demonstrate the ability to collaborate effectively in a collaborative environment.
• Possess excellent written and verbal communication skills.

Benefits

• Comprehensive health plans.
• Paid time off.
• Retirement savings.
• Corporate wellness.
• Educational assistance.
• Corporate discounts.
• And more.