POSITION DESCRIPTION UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing YOUR LIFE'S BEST WORK.(SM) The Appeals and Grievances Coordinator is responsible for reviewing, analyzing, and processing member appeals and grievances in accordance with State and Federal Guidelines for UnitedHealthcare Community Plan of North Carolina. This person ensures that Appeals and Grievances are resolved in a professional, expeditious manner. The Appeals and Grievances Coordinator is a resource for internal and external stakeholders and provides guidance on related processes and procedures. In this Greensboro, NC office based role, you will work directly with the appeals and grievances team members to ensure consistency across end-to-end appeals and grievance processes; evaluating, analyzing and making recommendations related to current processes and procedures, along with providing Health Plan oversight and support . This is a challenging role that creates an opportunity to grow and develop while doing YOUR LIFE'S BEST WORK. (SM) PRIMARY RESPONSIBILITIES:

• Ensures appropriate management and adjudication of appeals & grievances
• Provides oversight and support to Health Plan leadership in the administration of associated appeals and grievances policies and processes
• Facilitate Appeals and Grievances reviews, including scheduling meetings, requesting medical records, assembling appeal packets, maintaining meeting minutes, and drafting correspondence to members and providers
• Work with the Member Rights and Legal personnel to ensure Appeals and Grievances process are completed timely and according to contractual requirements and internal policies
• Work with different internal departments; Clinical, Member Services, Claims, Electronic Governance Communication Gateway, Care Managers, Prior Authorization, and key personnel to ensure Appeals and Grievances decisions/actions are implemented timely and according to contractual requirements and internal policies
• Serves as subject matter expert on contract requirements, including reporting, for the health plan
• Integrates federal and state law changes into company's regulatory system related to appeals and grievances
• Recommend solutions, and works with department and company staff to ensure problems are corrected and departments are advised of corrective measures to prevent recurrences
• Responsible for data and reporting requirements for Regulatory compliance, audits, Regulatory deliverables
• Role also supports State Fair Hearings, working closely with Health Plan's State Fair Hearing Specialist

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. REQUIRED QUALIFICATIONS:

• High School Diploma
• 3+ years of experience in health care / business / finance / government environment
• Strong verbal and written communication skills; must be able to present information in person and telephonically, as needed
• Must be able to shift priorities quickly and ensure all deliverables are met timely
• Ability to travel up to 20% of the time locally to other sites and/or within the State to attend trainings or meetings
• Ability to work Monday - Friday, 8-hour shifts during core business hours of 7am - 5pm

PREFERRED QUALIFICATIONS:

• Bachelor's degree in Business, Finance, Health Administration, related field or equivalent work experience
• Prior experience in health care, particularly in the area of appeals and grievances
• Experience with Government Programs (Medicaid and/or Medicare) and/or experience in insurance regulations
• Experience working with state and federal requirements, business operational requirements, policies, and procedures related to Grievances and/or Government Insurance Programs
• Previous experience in legal and/or paralegal fields
• Good technical writing capability

CAREERS AT UNITEDHEALTHCARE COMMUNITY & STATE. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do YOUR LIFE'S BEST WORK.(SM) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: Appeals and Grievances Coordinator, Appeals, Grievances, health care, business, finance, government, Government Programs, Medicaid , Medicare, federal requirements, business operational requirements, policies, procedures, Government Insurance Programs, legal, paralegal , State and Federal Guidelines , Regulatory compliance, audits, Regulatory deliverables, NC, North Carolina Job Details

• CONTEST NUMBER 847668
• JOB TITLE Appeal & Grievances Coordinator Greensboro, NC
• JOB FAMILY Medical and Clinical Operations
• BUSINESS SEGMENT Community and State

Job Location Information

• Greensboro, NC United States North America

Additional Job Detail Information

• EMPLOYEE STATUS Regular
• SCHEDULE Full-time
• JOB LEVEL Individual Contributor
• SHIFT Day Job
• TRAVEL No
• TELECOMMUTER POSITION No
• OVERTIME STATUS Exempt

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.