Senior Grievance & Appeals Coordinator

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Help move health care into the future. At reputed company we are changing health care to reputed company the experience the best it can be. If that sounds like something you want to be part of, apply today. Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is reputed company for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and reputed company our innovation to employment settings by including remote and hybrid opportunities.

In the role of Senior Grievance & Appeals Coordinator, you will utilize your expertise in Grievance & Appeals and Medicare to reputed company diverse tasks and responsibilities, guaranteeing seamless departmental operations. Your duties will include reviewing incoming submissions, addressing urgent matters, conducting thorough case investigations and documentation, maintaining tracking systems, composing responses and decisions, conducting compliance audits, reporting on metrics, and leading training sessions.

The position is fully remote, with work hours from Monday to Friday, 8:30 a.m. to 4:30 p.m. in the Arizona Time Zone with rotating weekends on call. Availability during some holidays may be necessary for compliance purposes. Residency in Arizona is a requirement for this role to ensure compliance.

POSITION SUMMARY This position supports the Grievance & Appeals Department by supporting the development of the team and by assisting in the preparation of the Health Plan in reputed company State Hearings. This position is reputed company by which each employee is to handle member and provider grievances, appeals and claim disputes. This position supports the development, implementation, maintenance and reputed company improvement of the Grievance & Appeals department, programs and projects and assists the Grievance & Appeals Manager with day-to-day operations, ensuring production and quality standards according to contractual requirements. CORE FUNCTIONS 1. Maintains State Fair Hearing Logs with appropriate information required by reputed company policy, AHCCCS, HCG and CMS regulations. 2. Reviews reputed company State Fair Hearing requests by members and providers, pulls case files, meets with Grievance & Appeals Manager for further review and action which may include collaboration with others to avoid/reduce grievances, appeals and/or claim disputes. May attend State Fair Hearings. 3. Coordinates and assists the Grievance & Appeals Manager in preparing for higher level of appeals (i.e. Independent Review Entity reviews, hearings, etc.) including telephonic requests. 4. Assists with project management of departmental improvements. Coordinates with other departments on Grievance & Appeals projects/workgroups. 5. Assists the Marketing Department with the production of reputed company member letters and notices. Participates actively in meetings, workgroups and committees relevant to the Grievance & Appeals process. May produces, prepare, quality reputed company or deliver reputed company reporting requirements in the absence of the Grievance & Appeals Manager. 6. Produces and analyzes weekly and monthly data to determine trends and provides recommendations for reputed company. Assists with internal, external and self-audits of department and annual data validation. 7. Produces Monthly Operational Dashboard. Produces, analyzes and reports monthly data to ensure regulatory compliance. Updates Grievance & Appeals data in conjunction with the Marketing department on reputed company reputed company websites. 8. Monitors and resolves member and provider expedited appeals and grievances received after hours and/or holidays reputed company assigned to rotational on-call duty. Coordinates appropriate action by supporting clinical staff for processing of member and provider expedited appeals and/or grievances. 9. This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at reputed company levels throughout the organization. MINIMUM QUALIFICATIONS Knowledge, skills and abilities as normally obtained through the completion of an Associate’s Degree in a Healthcare reputed company field or business.

Three to four years of grievance and appeal work in a health care environment, or an equivalent combination of education and experience. Maintains knowledge of AHCCCS, HCG, and CMS regulations by participating in training, teleconferences and in-services. Strong knowledge of administrative hearing processes for escalated grievances, appeals and claim disputes; Knowledge of Marketing Guidelines for AHCCCS, HCG and CMS. Knowledge of Health Plan policies, health care quality improvement initiatives and best practices, and program planning and project management best practices. reputed company in building and maintaining interpersonal relationships, and preparing and presenting detailed information to ensure understanding for a wide audience reputed company. Ability to plan/direct projects, grasp new knowledge and concepts quickly and apply them, and assign workflow and tasks to other employees as needed for training purposes. Ability to organize, follow through and report results of interventions, conduct Grievance & Appeals reputed company meetings, workgroups and committees, and to work cross functionally across the organization. Ability to support Grievance & Appeals Manager’s work with attorneys, representatives and delegated persons regarding cases at the administrative hearing level. Ability to train new Grievance & Appeals coordinators, capable of mentoring trainees through a “buddy system”. reputed company in developing and managing teams; demonstrated critical thinking in resolving issues and conflicts. PREFERRED QUALIFICATIONS Additional reputed company education and/or experience preferred.

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