CareSource · 15 hours ago
Grievance & Appeals Coordinator I
United States
Full-time
Remote
Entry Level
1+ years expCareSource is a healthcare management organization, and they are seeking a Grievance & Appeals Coordinator I. The role involves daily appeals logging, coordination of State Hearings, and ensuring compliance with regulatory guidelines for Medicaid and Medicare.
Health CareMedicalNon Profit
Responsibilities
Ensure regulatory compliance and HIPAA guidelines are met for Medicaid, Medicare, and future lines of business
Document appeals in Facets
Request medical/dental records from providers
Prepare all appeals and grievances and forward to the appropriate team once the information is received
Log State Hearings for Clinical Appeals Nurses
Complete appeal and State Hearing files to be ready for filing
Provide support to the department, including filing, printing, copying, including the preparation of new appeal and State Hearing files
Examine and identify ways to improve existing processes/workflows
Perform any other job-related functions as requested
Perform triage on incoming mail, emails, and faxes
Scan mail for retention in electronic files
Log and index grievances and appeals in Facets and Onbase
Create and mail acknowledgment letters for grievances and appeals
Forward State Hearing requests, external review requests and ALJ requests to the appropriate Market
Perform UAT Testing when necessary
Research appeals/grievances to determine validity
Log all appeals/grievances upon receipt in Facets
Stamp and sort incoming mail and direct or assign as appropriate
Route appeals to appropriate clinical personnel after documenting in Facets
Identify, sort, and deliver logged appeals/grievances for processing
Print and mail letters on denied appeals
Report monthly key statistics for all lines of business to the management team
Adhere to all policies and procedures, and ensure all guidelines set by regulatory bodies are followed and met
Perform any other job duties as requested
Qualification
Required
High School Diploma or equivalent required
Minimum of one (1) year of customer service, healthcare administration/management, or grievance and appeals experience required
Ability to analyze information
Communication skills
Ability to work independently and within a team environment
Excellent communication skills (both written and verbal) and ability to work with multi-disciplinary departments across the organization
Effective organizational and prioritization skills
Ability to manage time effectively
Attention to detail
Proper grammar usage
Critical listening and thinking skills
Proper phone etiquette
Customer service oriented
Decision making/problem solving
Change resiliency
Ability to accurately communicate summary information in a written format
Intermediate computer skills; Microsoft Word, Excel, and Access
Preferred
Associate Degree preferred
Managed Care experience preferred
Benefits
You may qualify for a bonus tied to company and individual performance.
Substantial and comprehensive total rewards package.
Company
CareSource
CareSource provides managed care services to Medicaid beneficiaries.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
FHLB Cincinnati
2026-01-17Grant
Leadership Team
Erhardt Preitauer
President & Chief Executive Officer
Jason Bearden
Market President and CEO, Georgia
Recent News
2026-01-18
Dayton Daily News
2025-12-17
Company data provided by crunchbase