Job Description Summary Coordinate the internal appeals and grievances process by supporting entry of requests in a meaningful and timely manner. Provide support as needed for the completion of appeals and grievances. Communicate information about appeals and grievances processes and outcomes to members and providers verbally and/or in writing. Support member and provider experience. •This is a 2-3 month contract position•

Essential Responsibilities:

Oversee and coordinate all Appeal activities ensuring response deadlines are met in accordance with applicable best practice, state and federal guidelines. Draft and provide acknowledgements by applicable method, to inquiries and appeals as required by regulations, and policy and department process standards. Ensure accurate and complete entry of case specific information into the Health Management Platform. Review original adverse benefit determination and provide information in the case to inform further process. Prepare and provide response and resolution by applicable method to inquiries and appeals as required by regulations, and policy and department process standards. Collaborate with team members to manage the timeliness of cases. Identify needs of the case spanning Commercial, Medicaid, and Medicare plans based on applicable state, federal, and NCQA guidelines.

Supporting Responsibilities:

Assist the Appeals and Grievances Support team in the entry of new appeals and grievances into the system. Meet department and company performance and attendance expectations. Follow the privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned.

SUCCESS PROFILE

Work Experience:

Minimum of two years customer service, claims processing or health insurance industry experience required. 1 year of technical writing and conflict resolution experience preferred.

Education, Certificates, Licenses:

High School Diploma required; bachelor's degree or equivalent experience preferred.

Knowledge:

Requires strong research, analytical and data entry skills. Experience using Facets, Onbase, and other software packages usedis strongly preferred. Must have basic math skills, the ability to work under strict deadlines, and excellent organizational skills.

Job Types:

Full-time, Contract, Temporary Pay:

$22.00 per hour

Work Location:

Hybrid remote in Springfield, OR 97477