Appeals and Grievances Administrator

Job title: Appeals and Grievances Administrator
Location: Philadelphia, PA
Duration: 3 Months+ (Possibility of Extension)
 
Duties:
The primary purpose of the job is to: Under the general supervision of the Director of Appeals and Grievances, this position screens calls from members and providers regarding the Part C, Part D and Medicare-Medicaid Plan appeals and grievances processes. In addition, the Coordinator will be responsible for retrieving grievances and appeals from the Customer Service database. This position will be located in our Philadelphia main campus office and will support the appeals and grievances needs of our Medicare Advantage D-SNP and MMP membership.
 
The Appeals and Grievances Coordinator will be responsible for:

• Coordinating the intake of appeal and grievances requests from members and providers into the designated systems.
• Generating Acknowledgement Letters to mail to appellants and answering general appeal status questions.
• Assist with compiling case files to be sent to Independent Review Entity (IRE).
• Rerouting requests to proper departments.
• Retrieving Grievance and Appeal request information from designated databases.
• Assisting Investigation and Appeals Specialists with appeal and grievance resolutions.
• Some availability on weekends and holidays to monitor work queues.

 
Education:

• High School/GED.

 
Skills:

• Medicare/Medicaid Experience and minimum of two years of experience dealing with the public.
• Medicare Advantage and MMP experience.
• Experience handling multiple call lines and triaging calls.