Coordinator, Medicare Complaints, Appeals & Grievances (MCAG) Position Available In Fulton, Georgia

Coordinator, Medicare Complaints, Appeals & Grievances (MCAG) 1.0 1.0 out of 5 stars Atlanta, GA 30339 • Remote Coordinator, Medicare Complaints, Appeals & Grievances (MCAG)

Sonder Health Plans Remote Salary Range:

$45,000 – $55,000 /yr # of positions: 1 Job Description Job Summary Responsible for the intake of Medicare Complaints, Appeals & Grievances (Member & Provider), in accordance with any contractual obligations, internal written standards and any applicable requirements established by the Centers for Medicare and Medicaid (CMS). Intake Coordinators prepare case files for Specialist and/or Clinical Reviewer processing and may assist with closing case files with proper documentation to ensure completeness of reviews. Knowledge/Skills/Abilities Responsible for intake, of all complaints, appeals and grievances from Sonder members and related outside agencies, while maintaining confidentiality in accordance with CMS guidelines. Responsible for intake, of all Non-Contracted Provider appeals from Sonder members and related outside agencies, while maintaining confidentiality in accordance with CMS guidelines. Responsible for intake, of all Contracted Provider appeals from Sonder Participating Providers and related outside agencies, while maintaining confidentiality in accordance with Sonder Health Plans contractual obligations with that provider. Ensures all cases have been organized, categorized and reported correctly. Prioritize and organize tasks to meet compliance deadlines. Assures timeliness and appropriateness of the intake process in accordance with state, federal and Sonder Health Plans’ policies and procedures as applicable. Prepares summaries, correspondence and documents for tracking/trending data when preparing case files for Specialist and Clinical Reviewer processing. Assists with closing case files with proper documentation to ensure completeness of reviews to meet any compliance standards. Ability to meet established productivity, schedule adherence, and quality standards. Communicates with the management team to correct problems ensuring customer satisfaction. Reliably and consistently meets work schedules, productivity requirements and deadlines. Attends meetings as required; Participates in employee orientation and training. Performs and assists in other duties and special projects as required. Job Qualifications Required Education High School Diploma or GED Required Experience Any Medicare Managed Care experience. Preferred Education Associate’s/Bachelor’s Degree or minimum of 1 years’ experience working with managed care plans. Preferred Experience Any medical office experience Experience with Centers for Medicare & Medicaid Services (CMS) systems and processes Familiarity with Medicare claims denials and appeals processing, and CMS guidelines for appeals, denials, and grievances.