VNS Health · 4 hours ago
Senior Coordinator, Grievance & Appeals
New York, NY
Full-time
Onsite
Mid, Senior Level
$28/hr - $35/hr
3+ years expVNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. They are seeking a Senior Coordinator for Grievance & Appeals to perform triage tasks, provide administrative support, and maintain regulatory compliance while ensuring timely and accurate processing of grievances and appeals.
CharityHealth CareHome Health CareNon Profit
Responsibilities
Identifies case types (e.g.- clinical vs non-clinical appeals) during the intake process, communicates and responds to department inquiries such as case status. Initiates follow up emails when additional information is required
Identifies the clinical appeal documentation needed for review by the G&A RNs by preparing cases and ensuring all pertinent information is included in the case file. Conducts preliminary review to determine the case level and type and records the findings in the case. Uploads and document information into the tracking database, identifying key information. Assigns cases according to established departmental processes
Assists with triaging cases for valid appeals and moving out of triage accordingly. Tracks the chain of custody of case records in and out of the department, according to established procedures. Maintains confidentiality of information
Maintains knowledge of Grievance and Appeals (G&A) procedures, and CMS and DOH regulatory requirements and timeframes applicable to the role, and prioritizes work accordingly
Assists with identifying, entering/updating missing data fields from the various systems that are necessary for the G&A database, including providing follow-up support to the RNs such as obtaining Initial Adverse Determinations notices
Prepares cases sent for external reviews in accordance with established procedures. Assists with entering the case into the G&A tracking system, tracks receipt, ensures that the reply is reviewed by the staff and implements action as appropriate
Prepares and issues template letters, including but not limited to acknowledgment letters, extension notices and clinical appeal decision letters. Prepares letters requesting Appointment of Representative (AOR) forms in grievances and appeals filed on behalf of the member's representatives. Prepares letters requesting Waiver of Liability (WOL) forms in appeals filed by non-participating providers. Follows up with the members and the providers via telephone and mail to request timely access to WOL and AOR forms as needed
Assists with updating of authorization related to overturned and partially overturned cases
Collaborates with the clinical team to ensure appropriate notices and follow- ups are completed and the third- party administrator staff to facilitate appropriate case files and updates are sent. Also collaborates with internal department staff to address inquiries, check case status, or requesting additional information
Recommends improvements in the effectiveness or efficiency of workflows for improved departmental operations and timely customer service
Participates in special projects and performs other duties as assigned
Qualification
Required
Associate's Degree in business administration, health care or related discipline or the equivalent work experience required
Minimum of three years of administrative support experience in a health care organization required
Proficient PC skills, including MS Excel, Word, and Access required
Excellent verbal/written communication skills required
Preferred
Bachelor's Degree in business administration, health care or related discipline preferred
Knowledge of DOH and CMS Grievance and Appeals regulatory requirements and procedures for ensuring compliance preferred
Knowledge of Facets system preferred
Benefits
Referral bonus opportunities
Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
Employer-matched retirement saving funds
Personal and financial wellness programs
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement
Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
Company
VNS Health
VNS Health provides home care, hospice care, and behavioral health services.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Dan Savitt
President and CEO
Aman Y. Shah
Vice President, New Ventures & Strategic Partnerships
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