The Grievances and Appeals Coordinator core function is to inform and educate plan members and practitioners on the process to properly submit a formal grievance and/or appeal. Additionally will manage, investigate and resolve member and practitioner grievances/appeals, to include appeals related to medication, medical, or service denials in accordance with Virginia Premier Health Plan’s (VPHP) policies and procedures as well as regulatory and accreditation requirements. The Grievances & Appeals Coordinator shall also be responsible for serving as the plan’s expert and liaison for the members and practitioners related to all grievance and appeals activities.
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia.
We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.
Our mission is to inspire healthy living within the communities we serve!
Equal Opportunity Employer All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.