Appeals and Grievance Coordinator
Largest Not-For-Profit Healthcare system in Houston looking for a new team member to help in the Appeals and Grievances Department. Located in Memorial City area, this location has a fast paced environment and is fortunately located to great lunch spots as well.
This position is centered on activities related to screening of appeals concerning customer complaints, medical necessity & claims appeals, and the coordination of Grievance and Appeals.
The main responsibility of this position is to manage and coordinate the provider and enrollee grievance/appeals process as well as initiation of Independent Review Organization (IRO) external reviews process as relates to Adverse Determinations based on non-medical necessity.
Working hours: 8:00 AM - 5:00 PM
-Ability to identify problems and present plans for resolution
-Data entry and collection
-Excellent verbal and written communication skills
-Working well under pressure and structured deadlines
-Assertiveness and negotiation skills
-Highest degree of professionalism and work ethic
-Desire to help others
-Complying with HIPAA Regulations
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