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Appeals and Grievance Coordinator

Location: 6630 Orion Drive, Fort Myers, FL
Department: Administration - VBSO
Categories: Clerical
Type: Full-Time
Shift: 8:00 AM-4:30 PM
Schedule: Days

Description:

The Grievance and Appeals Coordinator is responsible for receiving, investigating, and resolving compliance hotline referrals, member administrative appeals, grievances and provider administrative appeals. Resolutions of member issues will be in compliance with regulatory and accrediting agency standards. This position requires the following experience:

  • 2 years of experience in compliance services operations, utilization management, and/or processing appeals and grievances
  • 2 years of experience in healthcare, health plan, managed care organization or within a third part administrator
  • Understanding of appeals process and utilization management
  • Working knowledge of regulatory and accreditation requirements
  • Certified Coder preferred

Requirements:

Educational Requirements

Degree/Diploma ObtainedProgram of StudyRequired/
Preferred
and/or
Bachelor'sPreferred

Bachelor’s Degree or equivalent work experience required.



Experience Requirements


Required/
Preferred
Area of ExperienceRequired/
Preferred
and/or
2 YearsRequired
Program of Study

Additional Requirement

2 years of experience in compliance services operations, utilization management, and/or processing appeals and grievances

2 years of experience in healthcare, health plan, managed care organization or within a third part administrator

Understanding of appeals process and utilization management

Working knowledge of regulatory and accreditation requirements

Certified Coder preferred



State of Florida Licensure Requirements


and/orRequired/
Preferred
and/or
Program of Study


Certifications/Registration Requirements

3Required/
Preferred
and/or
Program of Study