Department Name: Grievances & Appeals Work Shift: Day Job Category: General Operations Estimated Pay Range: $23.16 - $34.74 / hour. Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained. Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities. In the role of Senior Grievance & Appeals Coordinator, you will utilize your expertise in Grievance & Appeals and Medicare to oversee diverse tasks and responsibilities, guaranteeing seamless departmental operations. Your duties will include reviewing incoming submissions, addressing urgent matters, conducting thorough case investigations and documentation, maintaining tracking systems, composing responses and decisions, conducting compliance audits, reporting on metrics, and leading training sessions. The position is Remote, with work hours between Monday to Friday, 8:00 a.m. to 5:00 p.m. Availability during some holidays may be necessary for compliance purposes. Residency in Arizona is a requirement for this role to ensure compliance. Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position supports the Grievance & Appeals Department by supporting the development of the team and by assisting in the preparation of the Health Plan in all State Hearings. This position is the standard by which each employee is to handle member and provider grievances, appeals and claim disputes. This position supports the development, implementation, maintenance and continuous improvement of the Grievance & Appeals department, programs and projects and assists the Grievance & Appeals Manager with day-to-day operations, ensuring production and quality standards according to contractual requirements. CORE FUNCTIONS 1. Maintains State Fair Hearing Logs with appropriate information required by HP policy, AHCCCS, HCG and CMS regulations. 2. Reviews all State Fair Hearing requests by members and providers, pulls case files, meets with Grievance & Appeals Manager for further review and action which may include collaboration with others to avoid/reduce grievances, appeals and/or claim disputes. May attend State Fair Hearings. 3. Coordinates and assists the Grievance & Appeals Manager in preparing for higher level of appeals (i.e. Independent Review Entity reviews, hearings, etc.) including telephonic requests. 4. Assists with project management of departmental improvements. Coordinates with other departments on Grievance & Appeals projects/workgroups. 5. Assists the Marketing Department with the production of all member letters and notices. Participates actively in meetings, workgroups and committees relevant to the Grievance & Appeals process. May produces, prepare, quality check or deliver all reporting requirements in the absence of the Grievance & Appeals Manager. 6. Produces and analyzes weekly and monthly data to determine trends and provides recommendations for intervention. Assists with internal, external and self-audits of department and annual data validation. 7. Produces Monthly Operational Dashboard. Produces, analyzes and reports monthly data to ensure regulatory compliance. Updates Grievance & Appeals data in conjunction with the Marketing department on all HP websites. 8. Monitors and resolves member and provider expedited appeals and grievances received after hours and/or holidays when assigned to rotational on-call duty. Coordinates appropriate action by supporting clinical staff for processing of member and provider expedited appeals and/or grievances. 9. This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization. MINIMUM QUALIFICATIONS Knowledge, skills and abilities as normally obtained through the completion of an Associate’s Degree in a Healthcare related field or business. Three to four years of grievance and appeal work in a health care environment, or an equivalent combination of education and experience. Maintains knowledge of AHCCCS, HCG, and CMS regulations by participating in training, teleconferences and in-services. Strong knowledge of administrative hearing processes for escalated grievances, appeals and claim disputes; Knowledge of Marketing Guidelines for AHCCCS, HCG and CMS. Knowledge of Health Plan policies, health care quality improvement initiatives and best practices, and program planning and project management best practices. Skill in building and maintaining interpersonal relationships, and preparing and presenting detailed information to ensure understanding for a wide audience base. Ability to plan/direct projects, grasp new knowledge and concepts quickly and apply them, and assign workflow and tasks to other employees as needed for training purposes. Ability to organize, follow through and report results of interventions, conduct Grievance & Appeals related meetings, workgroups and committees, and to work cross functionally across the organization. Ability to support Grievance & Appeals Manager’s work with attorneys, representatives and delegated persons regarding cases at the administrative hearing level. Ability to train new Grievance & Appeals coordinators, capable of mentoring trainees through a “buddy system”. Skill in developing and managing teams; demonstrated critical thinking in resolving issues and conflicts. PREFERRED QUALIFICATIONS Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy

Primary City/State: Phoenix, Arizona Department Name: Grievances & Appeals Work Shift: Day Job Category: General Operations Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities. Appeals and Grievances Management - Review, research, investigate, and resolve both verbal and written appeals and grievances from members and providers. - Ensure all cases are handled within required timeframes and regulatory guidelines. - Prioritize and multitask across multiple cases simultaneously. - Handle inbound and outbound calls related to appeals and grievances. - Provide clear, empathetic, and professional communication to members and providers. - Document all interactions and case progress accurately. - Maintain detailed and accurate records of case handling and resolutions. - Ensure all written communications are clear, grammatically correct, and compliant with internal standards. This role and training are remote. Arizona residency is required for this role for compliance. Shifts are Monday - Friday from 8:30 a.m.-5:00 p.m. If this role sounds like the one for you, apply today. Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position handles member and provider grievances, standard appeals and claim disputes. This position will act as a key advocate and contact for HP members with general health care and accessibility concerns and inquiries on the various levels of the grievance and appeals process. CORE FUNCTIONS 1. Determines which claim disputes meet acceptable claim dispute criteria, specifically screening for Untimely claims and Resubmissions; maintains a log, categorizes and tracks all received documents, notices, returned receipts; decides and responds to those appeals and claim disputes not meeting criteria with appropriate correspondence and routing. Assists in resolving member questions and concerns regarding the health care system in an effort to prevent the need for members to file formal grievances or appeals. 2. Enters all accepted appeals and claim disputes and its corresponding information into the CRM; creates and maintains case files, including appropriate review sheets for Medical Review and/or Claim Review according to policy, AHCCCS, HCG, and CMS regulations; updates CRM for ongoing cases with responses from reviewers. Assesses individual cases and documents in various CRM programs for pertinent information for referral and/or transmission to co-workers. 3. Ensures all appeals and claim disputes are acknowledged, by official correspondence, within AHCCCS, HCG, and CMS contractual timelines; protects the confidentiality of member information and other information. Facilitates, communicates and accepts input regarding member and provider appeal information from appropriate individuals that would include employees, providers, Medical Director, Plan Administrator, RNs, Risk Management, attorneys, AHCCCS, HCG, CMS and others. 4. Responds to all incoming phone calls, researches and resolves member and provider questions and concern regarding grievances, appeals and claim disputes. Opens, reviews, researches (if necessary), date stamps and routes or responds to all incoming mail. Responds in an expedient manner that is consistent with the mission and values of UAHN and in support of related regulations and policies and procedures to member, staff and physician grievances, appeals and claim disputes with minimal supervision. 5. Creates and submits all resolution and extension correspondence, utilizing appropriate Arizona Revised Statues, Arizona Administrative Code, Code of Federal Regulations, and other supporting regulatory policies and statutes for all UAHP managed plans. Self-audits daily to ensure compliance with regulatory requirements. 6. Recognizes, facilitates and gathers relevant medical records, coding and claim documentation that is required for the reviewers to fully investigate grievances, appeals, and claim disputes. Responsible for trouble shooting, identifying, and resolving special handling requirements related to grievance and appeal issues. 7. Reports at Grievance/Appeals meetings, as appropriate, all incoming, attended and scheduled State Fair Hearings. 8. Works internally with other departments in order to facilitate timely responses and inquiries, and assists with workgroups as requested. Provides technical expertise to other departments regarding grievances, appeals and claim disputes. 9. This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization. MINIMUM QUALIFICATIONS High school diploma/GED or equivalent working knowledge. Two years of work experience in health care related field or experience managing projects/initiatives, or an equivalent combination of education and experience. Knowledge of AHCCCS, HCG and/or CMS regulations. Knowledge of MS Word, Excel and Microsoft Office Suite required. Knowledge of Medical terminology, claims processing guidelines, and CRM & IDX. Knowledge of grievance, appeal and claim dispute processes. Strong interpersonal, organizational and problem solving skills. Strong oral and written communication skills required. Ability to work independently ensuring all deadlines/timelines are met and to work with various levels of healthcare professionals. Ability to be flexible and work on a variety of projects simultaneously under tight time constraints. Strong analytical, critical-thinking and time management skills. Strong organizational skills and ability to prioritize multiple tasks daily. Ability to quickly identify, summarize and present (verbally and orally) options to issues which may arise, and to consistently meet and exceed regulatory reporting requirements for all lines of business. PREFERRED QUALIFICATIONS Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy

• Responsible for providing support to the overall Commercial Operations function and Commercial Client Services Leaders • Tracking and aiding in adhering to a variety of organizational deliverables • Auditing processes • Ensuring best practices are shared across leaders • Pull reports and data from organizational dashboards to provide to auditors • Track productivity metrics to ensure the team meets Service Level Agreements (SLA) • Help monitor fill goals have been entered • Assist with & ensure teams are forecasting appropriately • Communication of progress, risks, expectations, timelines, milestones and other key project metrics to Service Delivery leaders and team members • Create and send weekly communication to Client Services Leaders ensuring adherence to different organizational deliverables and initiatives • Provide other administrative support to Commercial Operations and client services leaders as needed • Adapt global training materials and communications • Deliver localized training programs • Facilitate knowledge-sharing sessions to encourage the adoption of new tools and methodologies • Other duties as assigned.

• Communicating with customers via email to promptly resolve partner issues within established time frames. • Escalating complex issues to various cross-functional teams and monitoring escalations for end-to-end case management. • Documenting customer interactions and resolution paths, creating documentation for proactive and reactive issue resolution. • Maintaining a high level of customer satisfaction by providing timely and effective support.