Job Title: Grievance & Appeals Coordinator
Why work at OpTech?
OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, pleas e visit our website at www.optechus.com.
RESPONSIBILITIES:
Engagement Description:
- Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines
- Contact customers to gather information and communicate disposition of case
- Conduct pertinent research in order to evaluate, respond to, and finalize case
- Familiar with standard concepts, practices, and procedures for analyzing, interpreting data and applying contract and regulatory provisions
QUALIFICATIONS:
Top 3 Required Skills/Experience:
- Experience handling a large load of work in a fast-paced environment and have computer skills!
- Insurance, Medicare/CMS knowledge
- Customer Service Experience
Required Skills/Experience:
- Writing Letters
- Analytical thinker
- Research Skills
- Multi-task
- Two (2) years customer service experience required
Preferred Skills/Experience:
- Grievance and Appeals experience
- Degree in Healthcare/computer skills
- Experience in analyzing a claim
- Experience in classification between a grievance/appeal/organizational determination
- Letter writing
- Basic computer skills
- How to save a PDF, how to navigate excel, learning new systems
- Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred
- Strong project management skills preferred
Education/Certifications – Include:
- Healthcare, English
- High School Diploma or GED required
- Bachelor’s Degree in English, Communications or related field preferred
OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/