Coordinator, Intake

REMOTE, UNITED STATES

Description

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and One of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

We are seeking a Grievance and Appeals Coordinator to be a key member of the team. The Grievance and Appeals Coordinator is responsible for receiving, investigating, and resolving member administrative appeals, grievances and provider administrative appeals. Resolutions of member issues will be in compliance with regulatory and accrediting agency standards.

Responsibilities:

• Receive inbound calls, faxes, emails and mail to initiate an appeal or grievance request utilizing multiple software applications
• Collect, organize and track information received from a variety of resources to facilitate and expedite the processing of appeals and grievances
• Generate acknowledgment letters for member appeals and grievances in accordance with regulatory standards
• Review, research and correctly identify appeals, grievance or work that should be assigned to another department and process accordingly.
• Initiate and resolve member grievances in accordance with company and regulatory standards
• Initiate, research and refer member appeals to the Appeals RN
• Initiate, research and resolve provider appeals or refer to the Appeals RN, as necessary
• Generate resolution letters, as appropriate
• Utilize multiple internal and external computer applications and programs
• Meet established productivity and quality standards
• Perform other duties as assigned

Qualifications:

Required

• 2 years of experience in processing appeals and grievances
• 3 years of experience within a health plan, managed care organization or third party administrator
• Understanding of appeals process and utilization management
• Working knowledge of regulatory and accreditation requirements
• Excellent verbal and written communication skills

Preferred

• Certified coder
• Bachelor’s Degree