Appeals and Grievance Coordinator -Remote CSR
Job Description
Job Description
Title: Appeal & Grievance Coordinator
Customer Service Specialist- Appeals and Grievance coordinator -Remote
Location: Remote
JOB SUMMARY
This job reviews inquiries to determine if they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals; initiates a case file for each grievance and appeal; ensures compliance with organizational and regulatory requirements for member or provider issues; independently coordinates the resolution with internal/external parties as required; and documents and summarizes to all parties involved in the case the investigation results.
ESSENTIAL RESPONSIBILITIES
• Review inquiries to determine if they meet definition of appeal/grievance.
• Request and review all related relevant documentation and assemble case file.
• Coordinate resolution results and relay investigative results with all involved parties.
Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross functional teams to reduce trends.
•• May support the Quality Assurance, Appeal and other quality committees.
• Other duties as assigned or requested.
EDUCATION
Required
• High School Diploma or GED
EXPERIENCE
Required
3-5 years of relevant, progressive experience in the area of specialization.
Preferred
• Experience in Customer Service or a related field
SKILLS
• Knowledge of multiple processing systems and workflows • Knowledge of claims processing methodologies • Ability to interpret all government regulations Excellent organizational skills • Strong verbal and written communication skills
Company DescriptionAbout PRSG® – At Precision Recruiting Solutions Group®, we're all about you – the Accounting, Finance, and HR professionals. We specialize in understanding your career goals and values, matching you with tailored opportunities that align with your expertise. Our dedicated focus ensures you find employers who recognize and value your exceptional skills. Elevate your career in Accounting, Finance, or HR with us.
Company Description
About PRSG® – At Precision Recruiting Solutions Group®, we're all about you – the Accounting, Finance, and HR professionals. We specialize in understanding your career goals and values, matching you with tailored opportunities that align with your expertise. Our dedicated focus ensures you find employers who recognize and value your exceptional skills. Elevate your career in Accounting, Finance, or HR with us.