Government Programs Appeal Coordinator (1)

Summary

Investigating and responding to medical, pharmacy, and dental grievances, the full-time Government Programs Appeal Coordinator will manage appeals and inquiries while working remotely.Key responsibilitiesResearch and review grievances, complaints, and appeals, ensuring appropriate documentation and compliance with mandated timelinesCommunicate effectively with members, claimants, and other departments to facilitate fair reviews and responsesInterpret benefit contracts and respond to independent review entity requests, maintaining accurate documentation of case outcomesRequired qualificationsHigh School diploma or equivalent6 months to 2 years of experience in medical/dental claims processing or customer service preferredKnowledge of CMS rules for Medicare and Medicaid grievance processes preferredAbility to interpret benefit contracts and administrative policiesProficiency in computer applications such as Word and Excel

Job Description

Investigating and responding to medical, pharmacy, and dental grievances, the full-time Government Programs Appeal Coordinator will manage appeals and inquiries while working remotely.Key responsibilitiesResearch and review grievances, complaints, and appeals, ensuring appropriate documentation and compliance with mandated timelinesCommunicate effectively with members, claimants, and other departments to facilitate fair reviews and responsesInterpret benefit contracts and respond to independent review entity requests, maintaining accurate documentation of case outcomesRequired qualificationsHigh School diploma or equivalent6 months to 2 years of experience in medical/dental claims processing or customer service preferredKnowledge of CMS rules for Medicare and Medicaid grievance processes preferredAbility to interpret benefit contracts and administrative policiesProficiency in computer applications such as Word and Excel