Grievances amp Appeals Professional 2

Profile

Description

The Grievances & Appeals Professional 2 manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Grievances & Appeals Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Grievances & Appeals Professional 2 (formerly an Analyst role) assists team to further/support quality and compliance related goals. Analyze member/ provider Grievance and Appeals issues. Coordinating work activities. Often analyze work of others and/or is the primary administrative owner of a main process, program, product or technology. Works within broad guidelines with little oversight. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications


2-3 years of customer service experience
Prior grievance and appeals experience
Strong analytical skills
Strong data entry skills
Advanced experience with Microsoft Word and Excel
Experience handling multiple projects and assignments as directed by Management
Schedule: Monday- Thursday 8:00am-5:00pm and Friday 9:00am-6:00pm


Preferred Qualifications


Bachelor's Degree
Strong knowledge in Microsoft Access or experience with SQL Server databases
Previous experience processing grievances and appeals
Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish


Additional Information


Benefit package that starts your 1st day of employment
Robust 401k plan through Charles Schwab.
Eligibility for associate wellness and rewards program
Opportunity to learn the industry and build professional career
Tuition Reimbursement & Student Loan Refinancing


Scheduled Weekly Hours

40

Company info

Sign Up Now - WashingtondcCrossing.com