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Accountancy
0
Agriculture, Fishing
0
Finance, Insurance
0
Call Centres
0
Catering & Hospitality
0
Construction, Property
0
Customer services
0
Defence/Armed Forces
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Education
0
Electronics
0
Engineering, Manufacturing 0
Graduate, Trainees
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Healthcare & Nursing
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Human resources
0
IT & Internet
0
Legal
0
Management consultancy 0
Marketing, Advertising, PR 0
Media, Creative
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Non-profit, Charities
0
Public sector & Services
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Recruitment sales
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Retail, Wholesale
0
Restaurant & Food Service 0
Sales
0
Science
0
Secretarial, Administration 0
Security
0
Senior appointments
0
Telecommunications
0
Transport, Logistics
0
Travel, Leisure, Tourism
0
Other
0
| |
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Section: Construction, Property Vacancy 1262 |
| Post:Appeals & Grievances Coordinator |
Salary contractual |
| |
| Requirements and conditions |
| Age: |
Has no value
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| Gender |
Has no value
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| Education: |
no
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| Work schedule: |
Has no value
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| Work place: |
London
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| The announcement text: |
Job Title: Appeal and Grievance Coordinator
Location: White Plains, NY
Reports To: Appeals and Grievance Nurse Manager
Specific Job Functions:
1. The Appeals and Grievance Coordinators are responsible for ensuring timely and accurate resolution of member appeals and grievances identified through the call center/customer service departments as well as through written correspondence.
2. Complies with all aspect of CMS Medicare Managed Care Manual Chapter 13 and Part D Chapter 18, particularly as related to response timelines and notice requirements
3. Researches issues related to eligibility/enrollment, provider status, authorizations, benefit packages, and claim payment.
4. Uses Inquiry tracking function and makes phone calls to communicate with departments through out the organization and its vendors and delegates.
5. Makes follow-up phone calls to members/their representatives and providers.
6. Writes letters, completed forms, files, copies and utilizes tracking sheets and related information systems.
7. Assists with aggregating data and reporting as needed.
8. Performs other related duties as required.
Essential Skills and Qualifications
o Bachelor’s Degree in a social science or health care related discipline preferred.
o Minimum of two (2) years Medicare Advantage Appeals and Grievance knowledge strongly preferred.
o Experience with Medicaid Advantage Appeals and Grievances also preferred.
o Knowledge of CMS and NYSDOH appeals and grievance regulations and standards.
o S/he should possess strong verbal and written communication skills as well as analytical ability.
o Knowledge of Windows, Word, Excel a must. Historical experience with call or inquiry electronic tracking systems and databases strongly preferred
o Knowledge of ICD-9-CM, CPT, HCPCS, DRG, APC, OPPS, ASC coding systems as well as knowledge of various physician and facility billing & reimbursement methodologies.
o Knowledge of claims and medical management operations a plus.
o Have excellent decision-making abilities and judgment.
o Able to set priorities and work independently while recognizing issues that may have a departmental or organizational impact.
o Able to work at a fast paced, high volume environment and to multi-task.
o Some weekend coverage and holiday rotation required
Location: Manhattan, White Plains
Principals only. Recruiters, please don`t contact this job poster.
Please, no phone calls about this job!
Please do not contact job poster about other services, products or commercial interests.
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| Contact information |
| Employer: |
GlobalLogic Ukraine
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| Email: |
Montclair.hr@gmail.com.
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| Phone: |
8 (044) 492 9693
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Publication date: 2009-11-15 20:39:25
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