Appeal Resolution Specialist jobs in Johnstown, PA

Seeking a Grievance and Appeals Coordinator to enter appeals into the tracking system within contractual time limits. Responsible for reviewing and resolving member and provider complaints. The position is fully remote but MUST reside in INDIANA. The scheduled is Monday to Friday 8:00am-4:30pm.

Summary: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Job Responsibilities: Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail

Education/Experience: High school diploma or equivalent. Associate’s degree preferred. 0-2 years of experience.