• Claims Appeals and Grievance Coordinator

    Motion Recruitment Partners (Birmingham, AL)


    Claims Appeals and Grievance Coordinator

     

    Birmingham, Alabama

     

    Onsite

     

    Contract

     

    $18/hr - $28/hr

     

    Are you detail-oriented, highly organized, and passionate about making a difference in healthcare? We are seeking several Appeals and Grievances Coordinators for an onsite contract opportunity in Birmingham, AL. In this role, your organizational excellence and strong communication skills will help drive impactful results as you navigate complex appeals and grievances processes. The ideal candidate will demonstrate initiative, a proactive attitude, and the ability to manage multiple priorities effectively. Prior experience with Medicare Advantage is a plus; healthcare experience in any capacity is required. If you are ready to bring your skills and energy to a collaborative healthcare team, we invite you to apply!

     

    Contract Duration: 5 months

    Required Skills & Experience

    + High School Diploma or equivalent, Associates or Bachelors Degree a plus

    + A minimum of 2 years of related experience in claims, health, and clinical engagement and/or customer service

    + Strong verbal communication skills for complex issues with coworkers, departments, and external contacts

    + Clear, concise, and professional written communication

    + Experience researching claims, appeals, policies, and payment histories using company resources

    + Ability to make independent decisions and take responsibility for outcomes

    Desired Skills & Experience

    + Basic knowledge of CMS Managed Care guidance

    + Basic knowledge of Department of Labor guidelines and regulations pertaining to ERISA claim and appeal requirements

    + Basic knowledge of Inter-Plan processing standards and guidelines regarding Provider Appeals

    + Experience with medical issues and experience understanding medical terminology as it relates to the issues brought up appeals

     

    What You Will Be Doing

    Daily Responsibilities

    + Ensure accurate, timely responses to appeals and grievances from members, providers, and authorized representatives

    + Research claims, contract coverage, and corporate guidelines to resolve requests

    + Contact departments, customers, and providers for additional information as needed

    + Maintain strong relationships and clear communication with internal and external stakeholders

    + Draft approval and denial letters, including medical rationale

    + Document all information accurately for each request, ensuring completeness

    + Complete projects and cases within required timelines

    + Stay current on Health and Clinical Engagement programs, accreditation standards, and relevant regulations

    + Assess appeal qualifications for IRE review and coordinate the process

    + Handle special projects assigned by management

    + Monitor and respond to inquiries and resolutions within time requirements, including outbound calls as needed

    + Draft and respond to member correspondence sent to company executives

    + Check CMS HICS daily, research complaints, and assign them for appropriate resolution

    You will receive the following benefits:

    + Medical Insurance - Four medical plans to choose from for you and your family

    + Dental & Orthodontia Benefits

    + Vision Benefits

    + Health Savings Account (HSA)

    + Health and Dependent Care Flexible Spending Accounts

    + Voluntary Life Insurance, Long-Term & Short-Term Disability Insurance

    + Hospital Indemnity Insurance

    + 401(k) including match with pre and post-tax options

    + Paid Sick Time Leave

    + Legal and Identity Protection Plans

    + Pre-tax Commuter Benefit

    + 529 College Saver Plan

     

    Motion Recruitment Partners (MRP) is an Equal Opportunity Employer. All applicants must be currently authorized to work on a full-time basis in the country for which they are applying, and no sponsorship is currently available. Employment is subject to the successful completion of a pre-employment screening. Accommodation will be provided in all parts of the hiring process as required under MRP’s Employment Accommodation policy. Applicants need to make their needs known in advance.

     

    **Posted by:** Jessica Eisenberg

    Specialization:

    + Customer Support / Call Center / Client