Grievance & Appeals Coordinator-Medicaid exp

JOB DESCRIPTION

Under the general direction of the Grievance & Appeals Nurse Manager and Grievance Supervisor, the Grievance and Appeals Coordinator is responsible for completing administrative functions and supporting departmental activities for processing Grievance and Appeal cases. The Grievance and Appeals Coordinator is responsible for ensuring that IEHP personnel adhere to the guidelines established and outlined in the IEHP Grievance and Appeals Resolution System. The Grievance and Appeals Coordinator exercises independent judgment to ensure appropriate escalation protocols when trends or deficiencies are identified. Commitment to

Quality:

The IEHP Team is committed to incorporate IEHP s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Responsibilities:

Education & Experience Three or more (3+) years of administrative experience in an office environment, including use of Microsoft Office Suite. Demonstrated superior interpersonal and administrative skills commensurate with years of experience

Preferred:

Experience in a managed care Member Service/Customer Service environment. Prior Medi-Cal and Medicare experience helpful. Previous experience documenting and resolving Member and Provider grievances and appeals High school diploma or GED required Bachelor s degree from an accredited institution preferred Key Qualifications Excellent communication and interpersonal skills Strong organizational skills, typing 45 words per minute, proficient in Microsoft Word and Excel, and data entry experience are essential. Telephone courtesy Ability to handle multiple tasks Strong attention to detail and ability to prioritize work to ensure adherence to task deadlines Ability to learn and follow standards and procedures Positive Attitude and ability to work in a team setting