Member Appeals and Grievances Coordinator for Medicaid- Remote in Virginia!
At a glance
Job overview
Sentara Health is hiring a Member Appeals and Grievances Coordinator for Medicaid- Remote in Virginia!. Sentara Health Plans is seeking a Member Appeals and Grievances Coordinator for Medicaid. This full-time, permanent position involves investigating and documenting member appeals and grievances in compliance with state law and regulations. The coordinator will work closely with Medical Directors and the Appeals Manager to ensure proper handling of clinical and non-clinical appeals.
Key focus areas include Responsible for the investigation and documentation of member appeals and grievances., Works closely with the Plan's Medical Directors., and Works closely with the Appeals Manager..
Successful candidates bring High School Diploma Or Equivalent and Managed Care Experience. Important skills include Investigation, Documentation, JIVA, and Medicaid.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans is hiring an Member Appeals and Grievances Coordinator for Medicaid- Remote in Virginia!
Status: Full-time, permanent position (40 hours)
Standard working hours: 8am to 5pm EST, M-F.
Location: Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming
Job responsibilities:
- Responsible for the investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements. Works closely with the Plan's Medical Directors who are responsible for all decision regarding clinical appeals/ grievances and the Appeals Manager who is responsible for non-clinical appeals and grievances.
Education:
- HS - High School Grad or Equivalent REQUIRED
Certification/Licensure:
- None required
Experience:
-
Managed Care- 3 years REQUIRED
-
Previous member appeals and grievances experience preferred
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Experience in JIVA and Medicaid preferred
Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-102510
Talroo - Health Plan
Keywords: Health Plan, Healthcare, Health Insurance, MCO, Managed Care, Remote, Virginia, VA, Appeals, Claims, Grievance, Denials, Pre-authorization, Member, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming
Benefits: Caring For Your Family and Your Career • Medical, Dental, Vision plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • Paid Time Off and Sick Leave • Paid Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life Insurance • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education • Student Debt Pay Down – $10,000 • Reimbursement for certifications and free access to complete CEUs and professional development •Pet Insurance •Legal Resources Plan •Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.