Grievance Coordinator - Part Time

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Aloha Care’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.

Aloha Care’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.

The Grievance Coordinator is a key member of the Appeals and Grievance team, ensuring Aloha Care members and providers of compliant, ethical, and timely resolution of their grievance or appeal. The Grievance Coordinator strives toward excellent customer service, objective research, clear documentation, and responsiveness to our concerned members or providers. Tracking and reporting grievances and appeals, the Grievance Coordinator follows regulatory requirements of Medicaid and Medicare, accreditation standards of NCQA (National Committee for Quality Assurance), internal operational policies and procedures, and Aloha Care’s high touch Care Model.

Teaming up with the Grievance Lead, the Coordinator reports to the Manager of Organizational Quality Improvement and Accreditation.

• Reviews, researches and directs grievances and appeal cases to appropriate staff, and follows up to ensure that resolution has occurred, documentation is complete, required time frames are met, and proper written communication of the decision has occurred. In most cases, prepare the written communication of the decision in plain written language. Coordinates additional follow up activities with appropriate department managers and/or leads and tracks to conclusion.
• Maintains grievance and appeal logs in a timely manner for both lines of business. This includes logging incoming grievance, tracking dispositions and maintaining timeliness of resolution as required by state and federal mandates.
• Maintains electronic files of all documentation, and appropriate follow up documentation in member and provider memo screens, or other computer system modules or databases as per current workflows.
• Ensure that all information to providers, members, employees and other appropriate persons are accurate, consistent and customer sensitive.
• When needed for specific types of grievances or appeals, prepares summaries for committee review, documents meeting discussions, and communicates decision in writing.
• Prepare all Grievance & Appeals reports, as required by QUEST Integration, CMS, or other regulatory agencies per format and time frames specified. Report drafts are prepared in advance with sufficient time for internal management review.
• Participates in internal committee and interdisciplinary meetings, reporting recent activity and analysis of trends, and makes recommendations for problem resolution and performance improvement.
• Responsible for maintaining Aloha Care’s confidential information in accordance with Aloha Care policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to Aloha Care data based on the data classification assigned to this job title.

• Associates degree or equivalent combination of education and experience.
• Minimum of 1 year of related work experience.
• Achieves results, builds trust, communicate…