Healthcare Claims Coordinator - Appeals & Grievances

Healthcare Claims Coordinator - Appeals & Grievances at Pyramid Consulting, Inc Healthcare Claims Coordinator - Appeals & Grievances at Pyramid Consulting, Inc in Villa Park, California Posted in 7 days ago.

Type:

full-time

Job Description:

Immediate need for a talented Healthcare Claims Coordinator - Appeals & Grievances . This is a 06+ Months Contract opportunity with long-term potential and is located in Anaheim, CA(Onsite) . Please review the job description below and contact me ASAP if you are interested.

Job ID:

26-05632

Pay Range:

$25 - $27/hour. Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)

Key Responsibilities:

Manage full lifecycle of appeals and grievances (intake ? investigation ? determination ? closure) Review denied claims, benefit disputes, and quality of care concerns Draft clear, compliant determination letters (CMS, DMHC, NCQA) Collaborate with RNs, Medical Directors, Utilization Management, and Compliance teams Ensure all cases meet regulatory turnaround times (TAT) Maintain accurate, audit-ready documentation Communicate with members and providers regarding case status and outcomes

Key Requirements and Technology Experience:

5+ years of experience in Appeals & Grievances / Utilization Management / Case Management Strong experience with member appeals (NOT just billing or call center) Strong knowledge of

CMS, DMHC, NCQA

guidelines Proven experience writing appeal/determination letters Ability to manage high-volume caseloads with strict deadlines Experience with Medicare, Medi-Cal, and Commercial plans Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration. Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.