One of our clients, a renowned Healthcare provider in Watertown,MA, is looking for anAppeals and Grievances Department Coordinator to assist with all operational aspects of the Member Appeals and Member Grievances process for Commercial and Public Plans products. Ideal candidate must possess strong analytical skills and effectively interact with other departments to attain original claims processing details, as well as, solid data entry skills and excellent writing skills.
This is a temporary position and starts immediately.
Interested candidates may send us their resumes and we'll get in touch!
Distribution and classification of cases in compliance with applicable time-frames and regulations
Gathering information on behalf of the specialists with external vendors
Coordinating the request for medical records, tracking effectuates, facilitating delivery of appeals and related information to key departments and appeals committee members
Analyzing and reporting data regarding department processes as requested from management
Note trends in Member Appeals and Grievances and notify supervisors of their findings
Ensuring professional handling of Medicare Part D Appeals and Fast Track Appeals timely and in compliance with CMS regulations
HS diploma or GED
1+ year of work experience in a similar environment
Strong written communication skills, especially with grammar and spelling
Attention to detail and accuracy
Strong computer skills, must be able to run reports and manipulate/track/log data
Knowledge of Microsoft programs and CMS Guidelines
Experience with healthcare, medical, or pharmacy terminology is preferred