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Appeals and Grievances Intake Coordinator

Job Summary

The Intake Coordinator-Appeals and Grievance assists in the administration of timely resolution of appeals and grievances within state and federal guidelines, benefit plan guidelines, and company policies and procedures. The incumbent is expected to maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with any type of complaint and to make no disclosures of such information except to persons authorized to receive it in the conduct of business.

Qualifications

Required Education
High School Diploma or GED

Preferred Education
Associate's Degree

Required Experience
One (1) or more years of Medicare Advantage Part C experience
Proficient in Word, Excel and PowerPoint

Preferred Experience
Experience interacting with other healthcare professionals and proficiency in medical and pharmacy terminology

Major Work Activities
Monitors Plan systems and other methods of complaint (appeals, grievances, and CTM complaints) intake to ensure complaint reviews are started timely within the Appeals and Grievances department. Maintenance of logs and other methods in use to track and process appeals, grievances, and other complaints received by the plan. Access and triage inbound case requests for type and urgency with routing to appropriate analyst.
Maintains, updates and archives all complaint case files and data to assure easy and accurate retrieval of all related documents for internal and external use and reporting.
Prepares and generates complaint case files, notifications, mails letters, forms, and other complaint related notices including case file preparation, plan system updates and correspondence to members, prescribers, external agencies as well as internal staff and plan systems.
Provide assistance in conducting research including request of various documentation required to process appeals, complaints and grievances as well as proper
Other duties as assigned

Knowledge, Skills and Abilities
Customer service experience in managed care/Medicare setting
Strong in the following competencies:
Record Keeping
Communication, written and oral
Organizational Skills
Time Management
Ability to follow direction
Preferred experience in Medicare Appeals and Grievances case intake, document processing and communications

Sedentary Work
Exerting up to 10 pounds of force occasionally (up to 1/3 of the time) and/or;
A negligible amount of force frequently (1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.
Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Time:  Full time
Salary:  Hourly
Category:  Clinical/pharmacy/quality

Updated: 10/16/2018 2:00:45 PM

Job Contact:
Ira Protas
336-660-2002

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300 E. Wendover Ave.
Greensboro, NC 27401

336-660-2002