Appeals and Grievances Coordinator I
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. APPEALS AND GRIEVANCES COORDINATOR I Position DescriptionThis position is responsible for operational and administrative tasks related to the appeals and grievances (AG) process for State Programs, Commercial and Medicare products. Responsibilities include coordinating the identification, documentation, investigation and resolution of appeals in a timely manner according to regulatory timelines. Specific duties and responsibilities include:
- Analyze, answer, resolve, and document telephone calls from members, providers, internal departments, and external agencies, according to State, Federal or Commercial regulatory timelines. Monitor and research incoming appeals and grievances requests and inquiries; including potential expedites, from mail, voicemail, fax, Macess AG queue and email according to State, Federal or Commercial regulatory timelines. Contact members, providers and delegates as necessary to obtain information required to initiate appeals and grievances and educate on the process. Ensure all appeals and grievances are entered in the system and maintain accurate data according to State, Federal or Commercial regulatory guidelines. Investigate and conduct research in order to evaluate, respond to, and close appeals in accordance with State, Federal and Commercial regulatory timelines. Prepare second level reviews and submit to Maximus Federal Services. Prepare and present cases to Medical Directors, Pharmacists and leadership as needed for case resolution. Rotate shifts for weekend monitoring of, phones, e-mail and fax queue for urgent or expedited requests.
EducationBachelor's degree in health related field; demonstrated experience may be considered in lieu of degree.
Required Experience Experience with Medicare, Medicaid & Commercial benefit programs. Demonstrated experience in completing clear and meaningful written and verbal communication.
Preferred ExperienceExperience answering benefit and claim questions. Claims adjudication process experience. Experience in pharmacy utilization review. Amisys experience and proficiency in Microsoft Office program; Word, Excel and Access.
THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 8th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.