Grievance and Appeals Coordinator RPO Inc Little Rock, AR •

Remote Title:

Grievance & Appeals Coordinator Location:

REMOTE - AR

Duration:

3• Months Contract•

Target Start Date:

03/03/25 to 05/30/25

Shift:

8:00 AM - 5:00

PM CST Position Purpose:

Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. 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. Day-to-day responsibilities of this role and a description of the project: Reviewing faxes that come in from the providers and members who are appealing a denial of a medical claim. If it is a true appeal, then they will send the documents to a vendor that will review them. After the vendor makes their decision to uphold/overturn the claim, then they will follow the procedures of notifying the provider/member of the decision. We mainly do this by sending a letter, but on occasion, we have to call them.

Required Skills/Experience/Education:

2+ years of

RECENT Grievance/Appeals and Medical Claims Process Experience Outstanding Communication Skills:

Oral, written, and problem-solving skills; Strong Computer Skills, Strong Typing Skills 40 WPM, Strong Proficiency in Microsoft Office (Word, Excel, Outlook, Teams) Zoom, and SharePoint, Multitasking using multiple systems, and operation of office equipment. A wired, high-speed Internet connection is required, as a dedicated work area due to HIPPA Proof of High School Diploma/GED or higher is

REQUIRED.

Must have an on-hand copy of HSD/GED/Transcript/Degree.

Job Type:

Contract Pay:

$20.00 per hour

Benefits:

401(k) Dental insurance Flexible schedule Health insurance Paid time off Vision insurance

Schedule:

8 hour shift Day shift Monday to

Friday Experience:

Appeals/Grievance:

2 years (Required)

Medical Claims:

2 years (Required)

Location:

Little Rock, AR (Required) Ability to

Commute:

Little Rock, AR (Required)

Work Location:

Remote