Appeals & Grievances Coordinator I
Offer summary
Qualifications:
High school diploma or GED required; 1-2 years of related experience preferred., Previous healthcare, medical, or pharmacy experience is a plus., Excellent proofreading abilities and accurate data entry skills are essential., Knowledge of MS Office Suite, particularly Microsoft Word and Excel, is necessary..Key responsabilities:
- Evaluate and process Appeals and Grievances according to established work instructions.
- Perform outreach tasks to gather necessary information for processing Appeals and Grievances.
- Ensure timely finalization of Appeals and Grievances in compliance with laws and company policies.
- Provide excellent customer service and maintain confidentiality of member information.
Job description
Exemption Status:
United States of America (Non-Exempt)$37,271 - $47,525 - $57,779“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”
This position is not eligible for Sponsorship.
MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!
Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.
At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!
Job Description
The Appeals and Grievance (A&G) team manages all aspects of Appeals and Grievances processing including, but not limited to, intake, processing, notification, and compliance. This position, Appeal and Grievance Coordinator I, works as a member of the A&G team. Processing appeal and grievance requests in accordance with standards established for accuracy, timeliness, productivity, client performance commitments, and regulatory requirements (e.g. State Regulations, Federal Regulations, Professional Accreditations). Utilize various business applications (e.g. MedAccess, MedResponse Appeals, FileNet, RightFax, SalesForce) to perform analysis, obtain information, and enter data as required for assigned duties. Utilize reasoning skills to evaluate appeal and grievance requests for appropriateness and ensure processes are followed accordingly. Interact with internal and external customers as required. Work under general supervision, relying on work instructions, policies & procedures, and available company resources to perform the functions of the position efficiently and effectively.
Essential Functions and Responsibilities include but not limited to the following. Additional duties may be assigned.
- Evaluate and process Appeals and Grievances per establish work instructions and approved departmental documents.
- Perform and document outreach tasks (outbound calls or faxes) to obtain information necessary for processing Appeals and Grievances.
- Ensure Appeals and Grievances are finalized within the required turnaround time (TAT) in accordance with applicable laws and company policies.
- Provide and document required member and/or provider verbal notifications and review final written notifications for appropriateness.
- Provide excellent customer service and exhibit interpersonal communication skills (listening/verbal/written) when communicating with members and/or providers,
- Collaborating with internal departments to address issues and inquires and when interacting with co-workers.
- Protect and maintain confidentiality and privacy of all member’s personal and health information in accordance with federal requirements and company policies.
- Must comply with company and department policies, procedures, rules and regulations.
- Must possess the ability to adapt to departmental changes as required for the needs of the business. Must be flexible with shift changes.
Education and/or Experience
High school diploma or general education diploma (GED); 1-2 years related experience; or equivalent combination of education and experience.
Previous health care, medical or pharmacy experience preferred. Excellent proofreading abilities and accurate data entry skills. Able to work independently, with minimal supervision and work well in groups when required.
Computer Skills
To perform this job successfully, an individual should have knowledge of MS Office Suite. Knowledge of Microsoft Word and Microsoft Excel.
Certificates, Licenses, Registrations
Certified Pharmacy Technician and/or state licensure as a Pharmacy Technician required. Certified Pharmacy Technician Certification preferred.
The Perks:
- Medical / Dental / Vision / Wellness Programs
- Paid Time Off / Company Paid Holidays
- Incentive Compensation
- 401K with Company match
- Life and Disability Insurance
- Tuition Reimbursement
- Employee Referral Bonus
To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers
MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.
Equal Opportunity Employer, Male/Female/Disabilities/Veterans
OSHA/ADA:
To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Disclaimer:
The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
Required profile
Experience
Other Skills
- Social Skills
- Client Confidentiality
- Teamwork
- Adaptability
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