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Grievances and Appeals CoordinatorKelly Healthcare Resources - Woodland Hills, CAThe Grievances and Appeals Coordinator will receive, investigate and resolve member complaints, member appeals, and provider disputes. The position will provide resolution of the grievance situations in compliance with legal and regulatory requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES: * Researches, investigates and resolves administrative member complaints and appeals. * Assists with DMHC, URAC and Health Plan audit preparation. * Documents the results of complaints and appeals and dispositions at all levels including notification to providers and members. * Prepares case files on clinical member and provider appeals for medical director review. * Prepares clinical complaint resolution letters under guidance of clinical staff. * Processes, researches, and resolves provider disputes... See job listing >30+ days ago from Jobvertise - Save - Block - Flag - More Tools...
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Kelly Healthcare Resources
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Address:
1111 North Loop W
Houston, TX 77008
Phone: 713-864-5132
- Line of Business: Health/allied Services
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Key Numbers:
Company Type Private Company Revenue Less than $5M Company Size 10 - 100 employees
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