The Appeals and Grievance (A&G) Coordinator is responsible, per State and Federal regulations, for assisting with all operational aspects of the Appeals and Grievances assignment process for Point32Health. Responsibilities include, but are not limited to: processing daily mail received by the A&G department, distribution and classification of cases in compliance with applicable timeframes and regulations, gathering information on behalf of the A&G Analyst with external vendors, coordinating the request for medical records, tracking effectuations, facilitating delivery of appeals and related information to key departments and appeals committee members; analyzing and reporting data regarding department processes as requested from management; note trends in Appeals and Grievances and notify supervisors of their findings and ensuring professional handling of Medicare Part D Appeals and Fast Track Appeals timely and in compliance with CMS regulations. The coordinator must possess broad understanding of all Point32Health lines of business and benefit structures as well as have an understanding of regulatory requirements and timeframes. The Coordinator routinely interacts with providers and other internal and external constituents.
Essential functions will occur simultaneously; therefore, the employee must be able to appropriately handle each of these functions, prioritize them, and seek assistance when necessary. These essential functions need to be performed on a consistent and regular basis, using good judgment. The employee must have the ability to learn and apply Point32Health\xe2\x80\x99s policies and complex and frequently changing regulatory requirements consistently and the judgment to seek out guidance as needed.
Key Responsibilities/Duties \xe2\x80\x93 what you will be doing
MNCJobz.com will not be responsible for any payment made to a third-party. All Terms of Use are applicable.