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
High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. TITLE: Grievance & Appeals Coordinator I LOCATION: Baton Rouge, Louisiana REQNUMBER: 1219107 COMPANY: Clinical & Care Management POSITION TYPE: Both