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Seeking a Grievance and Appeals Coordinator to enter appeals into the tracking system within contractual time limits. Responsible for reviewing and resolving member and provider complaints. The position is fully remote but MUST reside in INDIANA. The scheduled is Monday to Friday 8:00am-4:30pm.
Summary: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Job Responsibilities: Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail
Education/Experience: High school diploma or equivalent. Associate’s degree preferred. 0-2 years of experience.
Full Time
Business Services
$43k-53k (estimate)
04/10/2024
06/08/2024
pme-indy.com
INDIANAPOLIS, IN
200 - 500
2005
HASKELL PORTEE
$10M - $50M
Business Services
PME is a Minority and Service Disabled Veteran Owned Business founded in 2006, that is a highly valued teaming partner in multiple states to large corporations such as Humana, KPMG, Ernst and Young, Anthem, and HP to name a few. Additionally, we provide services in the areas of healthcare, IT, and professional services to Department of Defense and other Federal Government clients. We also are highly engaged in state work in our home state of Indiana, as well as multiple other states nationwide. We successfully leverage our abilities in Healthcare, Managed Care, IT, and Human Capital Services w...ith our flexibility and robust performance.
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