Grievance And Appeals Coordinator (REMOTE)

Summary:

Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Job Responsibilities: Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information Assist with HEDIS production functions including data entry, calls to providers offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail

• Skills:*

claims appeal, medical terminology, medical customer service, provider relations, dual monitor

• Additional Skills & Qualifications:*

Education/Experience:

High school diploma or equivalent.

Associates Degree Preferred.0-2 Years Of Experience

• Experience Level:*

Expert Level

About Aston Carter:

At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless. Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit [AstonCarter.com.](AstonCarter.com) Aston Carter is a company within Allegis Group, a global leader in talent solutions. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email [[email protected]](mailto:%[email protected]) for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.