What are the responsibilities and job description for the Grievance & Appeals Coordinator position at LanceSoft, Inc.?
Job Descrption:
- Analyze, research, resolve and respond to complaints, appeals, and grievances from members, providers, and regulatory agencies with established regulatory and accreditation guidelines.
- Make appeals complaints and grievance decisions and communicate decision to the claimant within regulatory and accreditation guidelines for timeliness.
- Provide comprehensive appeals and grievances responses that support the decision and comply with regulatory and accreditation guidelines.
- Coordinate, facilitate, and conduct managerial-level conferences with customers and their authorized representatives.
- Stay abreast of internal policies and procedures and regulations for accurate resolution of appeals, complaints and grievances.
- Customer service/concierge experience
- Strong writing/letter writing and proofreading skills
- PC application/system skills, ability to navigate multiple computer systems and databases
- Be analytical, having the ability to examine a matter, the facts, contextual information and make an informed decision or implement and execute a reasonable, rational resolution
- Have high regard for quality of work, accuracy, and confidentiality
- Problem solving/conflict resolution
- Responding to appeals, grievances, complaints, HICS Marketplace
- Medical billing/medical terminology
- Bachelors degree