0416 - Appeals and Grievances Coordinator

Houston, TX 77001

Post Date: 08/16/18 Job ID: 00002TGW Industry: Healthcare Pay Rate: 17.00 - 19.00
Appeals and Grievances Coordinator needed on a long term basis with a large hospital system in West Houston. Position centered on activities related to screening of appeals concerning customer complaints, medical necessity and claims appeals, and the coordination of Grievance and Appeals. The primary responsibility 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. 5 years or more experience with processing appeals and grievances for the following lines of business: Medicare Advantage, Commercial Fully Insured, and Self-Funded plans.

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