Hybrid - Grievance and Appeal Coordinator - A-Line Staffing Solutions

A-Line is now hiring a Hybrid - Grievance and Appeal Coordinator in Alameda, CA. Grievance and Appeal Coordinator in would be working for a Fortune 500 company and has career growth potential. This would be full time / 40+ hours per week.

If you are interested in this Grievance and Appeal Coordinator position, please contact Mia Garrett atMgarrett@alinestaffing.com or 586-422-1209.

Grievance and Appeal Coordinator Compensation

• The pay for this position is $33 per hour
• Benefits are available to full-time employees after 90 days of employment
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates

Grievance and Appeal Coordinator Highlights

• Hybrid role. Expected to work 2 – 3 days a month in office
• Monday – Friday 8:00a – 5:00p PST

Grievance and Appeal Coordinator Responsibilities

• Thoroughly document the investigation and resolution of each case.
• Maintain an accurate and complete appeals/grievance record in the electronic database.
• Coordinate and prepare the Alliance component of the State Fair Hearing, MAXIMUS, Independent Medical Review (IMR), and DMHC appeal processes.
• Ensure compliance with state and federal regulations as they relate to appeal and grievance issues.
• Serve as the liaison with other departments to resolve grievance issues.
• Ensure timely communication with the Supervisor on all issues having potential risk and or impact on operations.
• Engage in special projects as assigned/requested.
• Other duties as assigned.

Grievance and Appeal Coordinator Requirements

• Ability to manage a caseload of a minimum of 60 cases a month.
• Coordinate non-complex grievance activities by receiving, handling, and resolving member issues and operational issues with other organizational staff.
• Achieve compliance, quality, and production standards.
• Ensure all cases and correspondence are managed in accordance with accreditation, regulatory, contractual compliance, and timeliness standards.
• Maintain pertinent documents, case files, and correspondence in an organized, confidential, and secure manner.
• Perform ongoing data entry.
• Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
• HS diploma or equivalent

Grievance and Appeal Coordinator Preferred Qualifications

• Associates and/or bachelor’s degree
• Knowledge of managed care and medical terminology
• Experience in a customer service or coordination in a health care setting or equivalent experience
• Excellent verbal and written communications skills
• Team player who builds effective working relationships
• Strong organizational skills
• Proficient experience in Microsoft Word, Excel, Access, Outlook, and PowerPoint
• Excellent verbal and written communication skills a must.

If you think this Grievance and Appeal Coordinator position is a good fit for you, please reach out to me - feel free to call, e-mail, or apply to this posting!

Mia Garrett – Recruiting Assistant

Mgarrett@alinestaffing.com or 586-422-1209

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