Appeals & Grievance Coordinator

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for an Appeals & Grievance Specialist to join our growing team.

Job Summary:

• The Appeals & Grievance Specialist is responsible for conducting thorough research and investigations to aid in resolving complaints and appeals.

Responsibilities:

• Assign mail cases to the correct area based on the level of appeal, such as admin appeal, retro, clinical, or external.
• Generate written correspondence, such as acknowledgment letters, to customers such as members, providers, and regulatory agencies.
• Document and log inquiry, appeal, and complaint information.
• Resolve cases within the necessary time to meet the turnaround time.
• Ensure proper resolution of inquiries, grievances, and appeals within specified times established by regulatory or accreditation agencies.

• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Required Qualifications

• Requires high school diploma or GED.
• Associate's degree from a business or secretarial school desired
• Excellent customer service skills.
• Basic data entry skills.

Preferred Qualifications

• Experience with customer service
• Previous experience in the health care industry preferred.
• Proficient in using MS Word, Outlook, and other relevant software.
• Possess strong critical thinking capabilities.
• Exhibit flexibility and good organizational skills.
• Demonstrate outstanding interpersonal skills.
• Ability to review cases and ensure that they are set up for the correct level of appeal.
• Capable of researching and resolving the outcomes of complaints.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.