Summary Description:
The Appeals and Grievances Coordinator provides administrative support to the Appeals and Grievances Department.
Representative Duties:
- Support the Appeals & Grievances (A&G) team in processing requests in a prompt and efficient manner.
- Effectively communicate and remind the team about special projects and priorities.
- Monitor the RightFax queue and A&G inbox; distribute or document incoming items into the appropriate case(s).
- Assist with maintaining the A&G calendar, including deadlines for the Department of Managed Health Care requests, responses, and effectuations.
- Enter new appeals or grievances received via email, mail, or by fax, retrieve relevant criteria, and classify case priorities (e.g. standard or expedited).
- Accurately identify, document, and maintain appeals/grievances, and related communications in internal system.
- Send notifications via fax/email notifications to providers and contracted entities, as needed.
- Assist A&G Specialists with follow-up and in obtaining additional information.
- Perform outreach to members or authorized representative(s), when requested, to obtain additional information and clarification.
- Responsible for daily incoming and outgoing mail, to include processing returned A&G department mail.
- File, scan, and upload documents, as required.
- Support team events, meetings, luncheons, and scheduling of conference rooms and calls.
- Maintain department procedures for administrative support duties and ensure consistent communication on processes.
- Provide backup support to the Senior A&G Analyst and A&G Supervisor on special projects.
- Provide administrative support to the A&G Supervisor, Utilization Management Supervisor, and Utilization Operations Director, as requested.
- Perform other duties and special projects, as assigned.
Qualifications:
- High School Diploma.
- 6 months experience working in an administrative role.
- 1 year experience in a customer service role.
- Previous experience working in the health care industry is a plus.
- Previous experience working with Facets and Salesforce Application Software is a plus.
- Intermediate computer skills, including electronic mail, routine database activity, word processing, spreadsheet, graphics, etc.
- Must be able to speak, read, write, and understand the primary language(s) used in the workplace
Salary:
$18.50 to $20.50 hourly
Western Health Advantage is committed to providing equal employment opportunities to employees and applicants for employment on the basis of merit and without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, medical condition, genetic information, marital status, ancestry, military or veteran status, or any other basis made unlawful by federal or state law.
Western Health Advantage values and supports the unique talents and strengths that each employee brings to our organization. Collaborating with the best and the brightest means a dynamic, fulfilling work experience for you — and excellent customer service for our members.
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