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Member Appeals and Grievances Coordinator
Location
United States
Posted
103 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Member Appeals and Grievances Coordinator
Sentara Health
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Sentara Health Plans is hiring a Member Appeals and Grievances Coordinator- Remote in Virginia! - Responsible for the investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements. - Works closely with the Plan's Medical Directors who are responsible for all decisions regarding clinical appeals/grievances and the Appeals Manager who is responsible for non-clinical appeals and grievances. Qualifications - HS - High School Grad or Equivalent (REQUIRED) - Managed Care - 3 years (REQUIRED) - Previous member appeals and grievances experience preferred Requirements - None required for Certification/Licensure Benefits - Medical, Dental, Vision plans - Adoption, Fertility and Surrogacy Reimbursement up to $10,000 - Paid Time Off and Sick Leave - Paid Parental & Family Caregiver Leave - Emergency Backup Care - Long-Term, Short-Term Disability, and Critical Illness plans - Life Insurance - 401k/403B with Employer Match - Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education - Student Debt Pay Down – $10,000 - Reimbursement for certifications and free access to complete CEUs and professional development - Pet Insurance - Legal Resources Plan - Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Job Requirements
- HS - High School Grad or Equivalent (REQUIRED)
- Managed Care - 3 years (REQUIRED)
- Previous member appeals and grievances experience preferred
- None required for Certification/Licensure
Benefits
- Medical, Dental, Vision plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- Paid Time Off and Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
- Student Debt Pay Down – $10,000
- Reimbursement for certifications and free access to complete CEUs and professional development
- Pet Insurance
- Legal Resources Plan
- Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
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This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium. X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. X Kneeling: Bending legs at knee to come to a rest on knee or knees. X Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet. X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time. X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Foot Motion: Using feet to push pedals. X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles. X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. X Grasping: Applying pressure to an object with the fingers and palm. Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Frequently Frequently Occasionally 2. PHYSICAL EFFORT (cont.) 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