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Reporting Medical Appeals Grievance Analyst
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Full-time
- Utilizes departmental software programs, including Microsoft Word to compose reports from data analysis, Microsoft PowerPoint to present comprehensive visuals, and Microsoft Excel to convert data from text files into an importable format to transfer data to a Microsoft Access database or a Microsoft Excel spreadsheet.
- Attends and successfully completes required annual mandatory training (SITEL) within the defined time frame.
- Process telephone calls from providers, other department staff, and members/enrollees in regard to complaints, compliments, grievance procedures, denials, and appeals.
- Triages provider inquiries regarding claim denials and payments and redirects to MFC Claims Auditing Dept or MFC Claims TPA to process provider inquiries.
- Works collaboratively with the Claims Auditor to ensure that payments by the MFC TPA are paid correctly based on fee schedules and applied business rules.
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