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AH
AllCare Health
Appeals & Grievance Coordinator
Career Insights for Registrar / Patient Service Representative
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Scorecard
Based on Oregon data
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What they do
A Registrar or Patient Service Representative provides direct assistance to patients at a health care or long term care facility. Answers questions and helps resolve complaints; provides liaison with health care providers; may assist with coordinating appointments or addressing billing or insurance issues.
$55,758 / year median in Oregon
+5% projected growth
Job Description
Appeals & Grievance Coordinator at AllCare Health with the Quality department in Grants Pass, Oregon We Are Seeking Qualified Candidates to Join Our Team! AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options. Summary This position is responsible for processing and resolving the Oregon Health Plan and Advantage Health Plan members and provider appeals and grievances by performing the following duties. Essential Duties Investigates and resolves complex member and provider complaints related to enrollment and claims, provider payment disputes, medical appeals, and reversals within the health care industry. Provides the medical director with a complete case file for processing of the appeals and grievances and coordinates care or payment of services. Forwards appeals to CMS Independent Review Entity or to DMAP for further review. Collaborates with DMAP, CMS, or the independent review entity for review. All relevant experience can be listed in your resume to perform essential duties of the position including the following: lived, volunteer, professional, or a combination of experience and education. Job Requirements May require the use of personal vehicle for local travel (subject to mileage reimbursement). Education & Experience Associate's degree (AA) from a two-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience. Certificates, Licenses and/or Registrations Certified Professional Coder (CPC) is strongly preferred. Physical Demands & Work Environment The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The noise level in the work environment is usually moderate. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties. The employee must be able to work on-site for all scheduled shifts.