Job Summary Homeland has partnered with a leading provider of employee benefits, specializing in dental health coverage for millions across the U.S. Our client is seeking a Bilingual Appeals and Grievance Coordinator to join their team.
As the Bilingual Appeals and Grievance Coordinator for their Medicaid dental and vision services team, you will play a crucial role in advocating for members by ensuring their concerns are addressed with care and efficiency.
You will oversee the entire appeals process, collaborating with various departments to achieve timely resolutions while maintaining regulatory compliance.
Your analytical skills will be essential in identifying trends and areas for improvement, enhancing the overall experience for our client.
Our client is committed to providing a fair and supportive process for Medicaid beneficiaries regarding their dental and vision services.
The team manages appeals and grievances, serving as a bridge between members and the healthcare system to resolve any issues they encounter.
They advocate for members' rights, ensuring their voices are heard and their concerns are addressed promptly.
By analyzing appeal trends, they continuously strive to improve services and create a seamless environment where every member can access the dental and vision care they need with confidence.
In this role, you will be the primary point of contact for members, providers, and clients concerning their appeals and grievances.
You will provide updates and ensure clear communication throughout the process.
Collaborating with internal teams, including claims, provider relations, and customer service, you will effectively resolve issues.
You will be responsible for the timely, accurate, compliant, and complete review and resolution of Medicaid dental and vision appeals and grievances.
Responsibilities Manage the full appeals process, ensuring timely and effective resolutionsDraft resolution letters promptly for all case files and store them in HEAT and the Shared DriveCommunicate with members and providers about case details, requests, and next steps with empathy and compassionAnalyze case details and make informed decisions based on regulatory requirementsMaintain accurate and organized records of all appeals and grievance casesUtilize electronic health records and claims processing systemsApply Medicaid guidelines and compliance standards for dental and vision servicesStay current with policy changes and implement them effectivelyPrioritize tasks to ensure compliance with turnaround time requirementsAnalyze data trends to identify issues and recommend improvementsExcellent verbal and written communication skills for conveying complex information clearlyStrong interpersonal skills for effective interaction with members and internal teamsStrong analytical and critical thinking skills for assessing situations and developing solutionsAbility to manage multiple cases and priorities efficientlyHigh level of accuracy in reviewing case information and documentationAbility to identify discrepancies and ensure complianceCollaborative mindset to work with cross-functional teams toward common goalsStrong relationship-building skills to foster a supportive work environment Requirements High School Diploma or equivalent2+ years of experience in appeals and grievances, preferably in the healthcare or insurance industryProficiency in Microsoft Office Suite and experience with claims processing systemsFlexibility to work a Saturday shift if requiredBachelor's degree in Healthcare Administration, Business, or a related field, preferredFluent in both oral and written communication in English and Spanish or Haitian-Creole, preferred1+ year of experience in a dental and vision and/or optical office, preferredRegistered Dental and Vision Hygienist or Dental Assistant, preferredStrong understanding of Medicaid policies and procedures, particularly related to dental and vision services, preferred Benefits Our client provides meaningful and challenging work that fosters innovation in a secure and compliant environment, alongside a competitive compensation package.
Benefits include comprehensive medical, dental, vision, life, and disability coverage for employees and their dependents with no waiting period, a 401(k) plan with company match, tuition assistance, paid parental leave, and backup family care.
Their collaborative workspaces encourage creativity and talent development, while flexible time off, dress code, and work location policies promote work-life balance.
The company values inclusion and diversity through Employee Resource Groups and is dedicated to social responsibility, community outreach, educational partnerships, and sustainability efforts.
Summary Apply today!
EEO Notice Homeland LLC is an Equal Opportunity Employer.
Homeland LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state, and local laws.
Homeland LLC complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.
Reasonable accommodation is available for qualified individuals with disabilities, upon request.