North Carolina Grievance Coordinator

A company is looking for a Grievance & Appeals Coordinator I.

Key Responsibilities

Analyze and resolve claims and authorization appeals from providers and formal grievances from members

Prepare response letters for member and provider complaints, grievances, and appeals

Maintain files on individual appeals and grievances and support related data entry and research functions

Required Qualifications

High school diploma or equivalent; associate's degree preferred

2+ years of healthcare grievance or appeals, claims, or managed care experience

Experience in managing large volumes of documents

Ability to support pay-for-performance programs

Familiarity with HEDIS production functions is a plus