What are the responsibilities and job description for the Healthcare Appeals Coordinator position at Point32Health?
About the Job
The Appeals & Grievances Coordinator plays a vital role in ensuring seamless operational aspects of the Member Appeals and Grievances process for Commercial, TMP, and Public Plans products. Reporting to the Supervisor, this position assists with distributing and classifying cases, gathering information from external vendors, coordinating medical records requests, and facilitating delivery of appeals information to key departments and committee members.
This coordinator must possess a broad understanding of all products and benefits, as well as regulatory requirements and timeframes. The role involves frequent interactions with providers and internal/external constituents. Essential functions are performed simultaneously, requiring strong prioritization skills and the ability to seek assistance when needed.
Key Responsibilities
- Assign new verbal and written appeals and grievances to Appeals and Grievances specialists
- Enter initial member appeals and grievances data into the system of record and maintain accuracy of appropriate data
- Review incoming appeals for potential expedites, assign and notify management as appropriate
- Classify grievances and appeals, track and ensure timely distribution of processes addressed by appeals and grievances specialists
