CTG GRIEVANCE & APPEALS COORDINATOR (MEDICARE) in Clayton, Missouri

Title: GRIEVANCE & APPEALS COORDINATOR (MEDICARE)

Location: US-MO-Clayton

Job Number: 17204420

Grievance & Appeals Coordinator (Medicare)

Our client in the healthcare industry has an immediate opportunity for a full time Grievance & Appeals Coordinator (Medicare) in Clayton, MO. This is a contract to hire opportunity!

Our client is now one of the largest providers of Medicaid, Medicare Advantage, and other government-sponsored and commercial programs in the country. They provide access to affordable healthcare to more than 11 million members across the country.

This is a great opportunity to work with one of the fast growing Fortune 500 companies that has a multi-line healthcare enterprise that provides services to government healthcare programs. If you are selected for this opportunity you will be surrounded by colleagues who are dedicated to meeting their own high standards, to inspiring their teammates and to making a positive impact on under-insured and uninsured individuals. Our client’s employees are fast, agile, customer-focused multi-taskers with a commitment to implementing the latest technologies. If these same things get you excited, we hope to hear from you.

Responsibilities:

Position Purpose: Review, investigate and track all Medicare grievances, appeals, and provider claims disputes submitted, and pursue formal resolution for members and providers within required guidelines

  • Screen all incoming grievances, appeals and provider claim dispute to ensure they are in compliance with CMS guidelines and the corporation’s policies

  • Gather, analyze and report verbal and written member and provider complaints, grievances and appeals

  • Prepare response letters for member and provider complaints, grievances and appeals

  • Conduct grievance and appeal investigations and provider claim dispute investigations through internal and external interviews, chart and contract audits, inspection, and interpretations of appropriate CMS guidance and policies

  • Maintain files on individual appeals and grievance cases

  • Manage the corporation’s grievance and appeals database

  • Coordinate with all relevant departments to streamline the appeals and grievance processes

  • Help prepare cases for Medicare Appeals Committee (MAC) review

  • Identify training, process improvement and other ways to maximize team performance and recommend action plans to management

Qualifications:

  • Associate’s degree in health care administration, social work, related field or equivalent experience.

  • 1 years of social work community relations or grievance and appeals experience, preferably in a managed care environment.

To Apply:

To be considered please immediately apply to this requisition using the link provided. For additional information please contact Shari Dowling at shari.dowling@ctg.com or 541-260-4087 .

Kindly forward to any other interested parties—thank you!

Qualifications:

CTG is the most reliable IT services provider, built on 50 years of meeting our commitments to make technology work for clients and deliver real business value. CTG provides industry-specific IT strategy, services, and solutions that address the business needs and staffing challenges of clients in high-growth industries, including major technology companies, large corporations, and government entities located in North America and Western Europe.

CTG's greatest asset is its people, and as such we are committed to providing employees programs and processes to support their performance, hone their skills, and advance in their careers. This commitment is reflected by CTG being named a Best Places to Work Company by Modern Healthcare (since 2013) in North America, and a Best Places to Work Company in the United Kingdom (2013), Belgium (since 2007), and Luxembourg (since 2011).

CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws.

CTG is an Equal Opportunity/Affirmative Action Employer and strong advocate of workforce diversity. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.

Job: Health Payer