appeals CoordinatorGenfinity

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Evolent Health has a bold mission to change the health of the U.S. 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 working in everything from scrubs to jeans.
Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as "Great Places to Work" in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation's Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.
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.
Grievance and Appeals Coordinator (Philippines)
Position Summary
Be a pioneer in this US Healthcare company that is coming soon to the Philippines! This US Healthcare company has MULTIPLE OPENINGS for Grievance and Appeals Coordinator who are energetic, eager individuals who would be a key member of the Appeals team.
For this role we are seeking skilled and knowledgeable healthcare individuals who are comfortable receiving, investigating, and resolving member administrative appeals, grievances and provider administrative appeals and supporting the clinical team with clinical appeals.
Roles & Responsibilities
Receive call, faxes, emails and mail to initiate an appeal or grievance request utilizing multiple software applications
Make outbound calls when necessary to obtain additional information pertaining to the research of an appeal or grievance.
Collect, organize and track information received from a variety of resources to facilitate and expedite the processing of appeals and grievances
Initiate, research and resolve member grievances in accordance with company and regulatory standards
Initiate, research and refer member appeals to the Appeals
Document substance of grievance/appeal request to company policy and standards
Utilize multiple internal and external computer applications and programs
Meet established productivity and quality standards
Perform other duties as assigned
QUALIFICATIONS:
Bachelor's degree in allied health profession preferred (Nursing, Physical Therapy, Occupational Therapy, etc.)
An active and unrestricted Nursing License in the Philippines Experience in US Healthcare is an advantage
Knowledge in utilization management process preferred Experience in Medicare Advantage plan with knowledge of CMS guidance/regulations for appeal and grievance processing preferred
Experience with Erisa/NCQA/State regulatory requirements related to appeals and grievances is an advantage
Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills
Must possess good written and oral communications skills, organizational skills; be proficient in decision making, problem solving, and time management.
Typing speed of >45 words per minute preferred.
Ability to multitask in a fast-paced environment
Proficient in MS Outlook, Word and Excel and general computer literacy, working with dual screens·
Ability to maintain strict confidentiality of protected health information
Strong written and oral communication skills
Hours of Training and Operation: US Business Hours
Trainees will be required to maintain regular attendance and successfully complete the required training and demonstrate proficiency of the material at the end of training.
Compensation & Benefits
Earn as much as ₱45,000 up to ₱55,000 per month;
HMO coverage includes you and a dependent.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
Evolent Health intends to establish a great working environment in the Philippines and offers a competitive benefit package. Candidates offered a position must be able to successfully pass the background check. * Skills testing may be required. Employees will initially be hired by Genfinity with the expectation that they will be transferred to Evolent.
Genfinity

Makati City, Metro Manila
₱55,000 per month
Permanent
Full-time