Appeals & Grievance Specialist

Southwest
Immediate

Job Description

Innovative, Dynamic, Fast Pace and Collaborative, these are just some of the words that our employees use to describe us but hey - don’t just take it from us - become a part of BroadPath today and experience our Culture of Constant Connection! BroadPath is immediately hiring Appeals and Grievance Coordinator to work from home, we want you! The Appeals and Grievance Coordinator will be responsible for managing, coordinating, and resolving member and provider complaints, grievances, and appeals, ensuring compliance with state and federal regulatory requirements. Our Appeals and Grievance Coordinator will act as the primary investigator and contact person for the member and provider and perform research, resolution, and response to complaints on behalf of a member.

Responsibilities

  • Sending appropriate acknowledgment of the grievance/appeal; educating the member or provider about the grievance/appeal process and their right to appeal to state or federal agencies (if applicable)
  • Gathering all relevant information from the member or provider regarding the grievance/appeal and determining the appropriate resolution of the grievance/appeal per standard policies and procedures.
  • Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue
  • Conducts non-biased, accurate, timely, and comprehensive investigation of all the facts related to the grievance/appeal
  • Thoroughly documents all action taken on behalf of the member or provider to resolve the grievance/appeal
  • Ensures that all grievances/appeals are processed in adherence to state and federal regulations

Basic Qualifications

  • 1 years of Medicare Appeals/Grievance experience or Medicare Claims experience required
  • VAM system experience required
  • Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
  • Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
  • Excellent verbal and written communication skills
  • Ability to remain focused and productive each day though tasks may be repetitive
  • High school diploma or equivalent

Preferred Qualifications

  • Processing Medicare Appeals/Grievance with Medicare Part C or D experience