Appeals and Grievances Administrator

Your career starts now. We''re looking for the next generation of health care leaders.At AmeriHealth Caritas, we''re passionate about helping people get care, stay well and build healthy communities. As one of the nation''s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we''d like to hear from you.Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at This role is eligible for a $1,500 sign-on bonusResponsibilities: 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/Experience:High School/GED.Medicare Advantage and MMP experience.Medical terminology, ICD, CPT and coding experience.Experience handling multiple call lines and triaging calls.1-3 years Medicare/ Medicaid Experience and minimum of two years of experience dealing with the public. BackShareApply Now

Created: 2021-11-29