Grievance & Appeals Coordinator

Banner Health

Banner Health coordinator managing Arizona healthcare-plan grievances, appeals, and claim disputes. Researching cases, coordinating reviews, and preparing compliant member and provider correspondence.

Posted 8/5/2026part-timeRemote • Arizona • 🇺🇸 United StatesJuniorMid-Level💰 $20 - $30 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing healthcare claims disputes, appeals, and grievances while ensuring compliance with AHCCCS, HCG, and CMS regulations. Proficient in utilizing CRM systems and Microsoft Office Suite to maintain accurate records and facilitate communication among healthcare professionals.

Highest-signal resume keywords

Healthcare Claims ProcessingAHCCCS, HCG, CMS RegulationsCRM System ManagementMedical Terminology KnowledgeGrievance and Appeal Processes

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingRegulatory ComplianceDocument ManagementData EntryMedical Record Gathering

Soft Skills

Interpersonal SkillsOrganizational SkillsProblem-Solving SkillsCommunication SkillsTime Management Skills

Tools & Technologies

Microsoft Office SuiteCRM SystemsIDX

Industry Keywords

HealthcareGrievanceAppealClaim DisputeConfidentiality

About the role

Key responsibilities & impact

Determine which claim disputes meet acceptable criteria, screen untimely claims and resubmissions, maintain logs, categorize and track documents, and route or respond to appeals and disputes
Assist members with healthcare questions and concerns to help prevent formal grievances or appeals
Enter accepted appeals and claim disputes and corresponding information into CRM systems
Create and maintain case files and review sheets for medical and claim reviews
Update CRM records with reviewer responses and document information for referrals or transmissions
Acknowledge appeals and claim disputes through official correspondence within AHCCCS, HCG, and CMS contractual timelines
Protect the confidentiality of member and provider information
Coordinate appeal information with employees, providers, Medical Director, Plan Administrator, RNs, Risk Management, attorneys, AHCCCS, HCG, CMS, and others
Respond to calls and research and resolve member and provider questions regarding grievances, appeals, and claim disputes
Review, date stamp, route, or respond to incoming mail
Create and submit resolution and extension correspondence using applicable statutes, regulations, policies, and procedures
Self-audit daily for regulatory compliance
Gather medical records, coding, and claim documentation for reviewers
Troubleshoot and resolve special handling requirements related to grievance and appeal issues
Report incoming, attended, and scheduled State Fair Hearings at grievance and appeals meetings
Work with internal departments to facilitate timely responses and inquiries
Assist with workgroups and provide technical expertise on grievances, appeals, and claim disputes

Requirements

What you’ll need

Must reside in the state of Arizona
High school diploma/GED or equivalent working knowledge
Two years of work experience in a healthcare-related field or experience managing projects/initiatives, or an equivalent combination of education and experience
Knowledge of AHCCCS, HCG, and/or CMS regulations
Knowledge of Microsoft Word, Excel, and Microsoft Office Suite
Knowledge of medical terminology, claims processing guidelines, CRM, and IDX
Knowledge of grievance, appeal, and claim dispute processes
Strong interpersonal, organizational, and problem-solving skills
Strong oral and written communication skills
Ability to work independently and meet deadlines and timelines
Ability to work with various levels of healthcare professionals
Ability to manage multiple projects simultaneously under tight time constraints
Strong analytical, critical-thinking, and time-management skills
Ability to prioritize multiple daily tasks
Ability to identify, summarize, and present issue options verbally and orally
Ability to meet and exceed regulatory reporting requirements
Completion of post-offer occupational health physical assessment, drug screen, and background check required

Benefits

Comp & perks

Registry/Per Diem positions do not have guaranteed hours and no medical benefits package is offered
Comprehensive benefit package for all benefit-eligible positions
Remote work opportunity
Drug-free work environment