Grievance Coordinator

Job Overview

Akkodis is partnering with a local Health Plan who is hiring a Grievance Coordinator for a temporary 3-month contract.

• Temporary 3-month contract
• Remote (must pick up equipment)
• $28/hr W2

• 3+ years’ experience as a Service Representative or similar position
• Medi-Cal experience
• 1+ year experience as a Grievance Coordinator
• Managed Care experience preferred
• Associates Degree or at least 2 years post high school education
• Advanced Word and Excel skills.
• Experience working with Outlook, MS Teams, and PDF documents
• Experience taking incoming calls with members and provider offices
• Familiarity with Electronic Medical Records/Charting

• Receives and/or identifies grievances through a variety of sources.
• Reviews grievance documentation for accuracy and conformance with standards; research using a variety of methods, and internal and external resources.
• Identifies appropriate action; makes or recommends adjustments.
• Sends out member communications according to mandated time frames.
• Monitors and tracks grievances to ensure resolution within mandated time frames.
• Contact person during state audits related to grievances; may interact with state directly on individual cases.
• Compiles, formats and prepares routine reports for distribution to internal and external stakeholders; coordinates review and distribution.
• Documents actions into appropriate systems.

• Produces work that is accurate and complete.
• Produces the appropriate amount of work.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Basic knowledge of the grievance process.
• Strong knowledge of medical policy benefits and exclusions.
• Strong knowledge of Medi-Cal programs and regulations.
• Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
• Basic analytical skills, including the ability to perform routine analysis, using identified data, information and/or issues, and provide recommendations.
• Ability to treat confidential information with appropriate discretion.

Equal Opportunity Employer/Veterans/Disabled

Benefit offerings include medical, dental, vision, term life insurance, short-term disability insurance, additional voluntary benefits, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State or local law; and Holiday pay upon meeting eligibility criteria.

Disclaimer:
These benefit offerings do not apply to client-recruited jobs and jobs which are direct hire to a client.

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The Company will consider qualified applicants with arrest and conviction rec

Associate

Temporary

Administrative

Hospitals and Health Care